Healthcare Provider Details

I. General information

NPI: 1386561686
Provider Name (Legal Business Name): MRS. LISA RENEE NORDHEIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E 2ND ST LOT I
MANCHESTER OH
45144-1595
US

IV. Provider business mailing address

710 E 2ND ST LOT I
MANCHESTER OH
45144-1595
US

V. Phone/Fax

Practice location:
  • Phone: 513-316-4177
  • Fax:
Mailing address:
  • Phone: 513-316-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRS378893
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: