Healthcare Provider Details

I. General information

NPI: 1841523032
Provider Name (Legal Business Name): LISA DAINA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2009
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HTS OH
44124-2203
US

IV. Provider business mailing address

1548 FORESTBROOK LN
PAINESVILLE OH
44077-1293
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-4500
  • Fax:
Mailing address:
  • Phone: 440-823-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024277
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.121445-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: