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NPI Code Detail

MEDICARE: MRS. LISA JO AICHHOLZ CNP

MEDICARE: MRS. LISA JO AICHHOLZ CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerNP-08003OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285858241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA JO AICHHOLZ CNP
Provider Business Mailing Address
First Line : 202 N CENTER ST
Second Line :
City : NEW WASHINGTON
State : OH
Zip : 44854-9703
Country : US
Telephone Number : 419-492-3334
Fax Number :
Provider Business Practice Location Address
First Line : 1400 W MAIN ST
Second Line :
City : BELLEVUE
State : OH
Zip : 44811-9088
Country : US
Telephone Number : 419-483-4040
Fax Number : 419-483-1307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 07/08/2007

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