MEDICARE: LISA WILLIER RN

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
1	163W00000X	Registered Nurse	RN228006	OH

General Provider Information

NPI Number	:	1427896661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WILLIER RN

Provider Business Mailing Address
First Line	:	4648 CARSKADDON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1180
Country	:	US
Telephone Number	:	419-280-9333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4648 CARSKADDON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1180
Country	:	US
Telephone Number	:	419-280-9333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2024
Last Update Date	:	07/19/2024

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