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General NPI Number Information
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NPI Number | 1063651461
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Entity Type | Individual
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Provider Name | LISA LYNN KNISKA NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 02/10/2009
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 3685 STUTZ DR STE 101
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City | CANFIELD
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State | OH
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Zip | 44406-9155
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Country | US
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Telephone | 330-259-0440
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Fax | 330-259-0441
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Provider Business Mailing Address
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Address Line | 3685 STUTZ DR STE 101
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City | CANFIELD
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State | OH
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Zip | 44406-9155
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Country | US
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Telephone | 330-259-0440
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Fax | 330-259-0441
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP10260
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License Number State | OH
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