Healthcare Provider Details

I. General information

NPI: 1366882565
Provider Name (Legal Business Name): LISA MICHELLE OHANNON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 COTTMAN AVE
PHILA PA
19111-3816
US

IV. Provider business mailing address

1575 ROTHLEY AVE
WILLOW GROVE PA
19090-4819
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-4378
  • Fax:
Mailing address:
  • Phone: 267-231-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN806220
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: