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General NPI Number Information
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NPI Number | 1548461593
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Entity Type | Individual
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Provider Name | LISHA MICHELE BLUE CNP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 135 N EWING ST SUITE 302
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City | LANCASTER
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State | OH
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Zip | 43130-3382
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Country | US
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Telephone | 740-689-6430
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Fax | 740-689-6431
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Provider Business Mailing Address
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Address Line | 1153 E MAIN ST P.O. BOX 2563
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City | LANCASTER
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State | OH
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Zip | 43130-4056
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Country | US
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Telephone | 740-687-8990
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Fax | 740-687-8230
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 06595
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License Number State | OH
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