Healthcare Provider Details

I. General information

NPI: 1407791106
Provider Name (Legal Business Name): LISA TAADEME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5874 MURTAGH DR UNIT 206
GALLOWAY OH
43119-3512
US

IV. Provider business mailing address

5874 MURTAGH DR UNIT 206
GALLOWAY OH
43119-3512
US

V. Phone/Fax

Practice location:
  • Phone: 380-444-9370
  • Fax:
Mailing address:
  • Phone: 380-444-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: