Healthcare Provider Details

I. General information

NPI: 1790458230
Provider Name (Legal Business Name): LISA YVONNE CARNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 MECHANICSBURG RD
SPRINGFIELD OH
45503-3147
US

IV. Provider business mailing address

1918 MECHANICSBURG RD
SPRINGFIELD OH
45503-3147
US

V. Phone/Fax

Practice location:
  • Phone: 937-398-0274
  • Fax: 937-399-3112
Mailing address:
  • Phone: 937-398-0274
  • Fax: 937-399-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.205372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: