Healthcare Provider Details

I. General information

NPI: 1942784814
Provider Name (Legal Business Name): LISA MARIE CAMPBELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 12/15/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAMILY HEALTH AND SURGERY CENTER 5700 COOPER FOSTER PARK ROAD
LORAIN OH
44053
US

IV. Provider business mailing address

1210 LAGUNA DR
HURON OH
44839-2607
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-5000
  • Fax:
Mailing address:
  • Phone: 419-656-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07182461
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: