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NPI Code Detail

MEDICARE: LISA M MOORMAN CNP

MEDICARE: LISA M MOORMAN 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 Practitioner1102028KY
2363L00000XNurse Practitioner07397-NPOH
3363LA2200XAdult Health Nurse PractitionerAPRN.CNP.07397OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548225873
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M MOORMAN CNP
Provider Business Mailing Address
First Line : 5053 WOOSTER RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45226-2326
Country : US
Telephone Number : 513-751-2145
Fax Number : 513-751-1848
Provider Business Practice Location Address
First Line : 3050 MACK RD STE 300
Second Line :
City : FAIRFIELD
State : OH
Zip : 45014-5376
Country : US
Telephone Number : 513-751-2145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 04/19/2021

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Directions to “ LISA M MOORMAN CNP” Practice Location

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