Healthcare Provider Details

I. General information

NPI: 1184020810
Provider Name (Legal Business Name): LISA OLIVER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 STATE ROUTE 170 STE A
EAST LIVERPOOL OH
43920-9672
US

IV. Provider business mailing address

15655 STATE ROUTE 170 STE A
CALCUTTA OH
43920-9672
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax: 216-229-2630
Mailing address:
  • Phone: 330-386-4303
  • Fax: 216-229-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019377
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN630490
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: