Healthcare Provider Details

I. General information

NPI: 1013253707
Provider Name (Legal Business Name): LISA LYNNE LEESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 DUSTIN RD STE C
OREGON OH
43616-3497
US

IV. Provider business mailing address

2200 JEFFERSON AVE FL 5
TOLEDO OH
43604-7102
US

V. Phone/Fax

Practice location:
  • Phone: 419-691-5716
  • Fax: 419-691-3340
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.14008
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberCOA 14008 NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: