Healthcare Provider Details

I. General information

NPI: 1124373816
Provider Name (Legal Business Name): LISA GOINS PHD APRN FNP-BC RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N BROOKWOOD AVE
HAMILTON OH
45013-1306
US

IV. Provider business mailing address

201 N BROOKWOOD AVE
HAMILTON OH
45013-1306
US

V. Phone/Fax

Practice location:
  • Phone: 513-857-5679
  • Fax:
Mailing address:
  • Phone: 513-857-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.13621-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008409
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: