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NPI Code Detail

MEDICARE: MS. LISA LIGHT

MEDICARE: MS. LISA LIGHT
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
1163W00000XRegistered NurseRN 303551OH

General Provider Information

NPI Number : 1922409119
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA LIGHT
Provider Business Mailing Address
First Line : 4726 MAIN AVE
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-6929
Country : US
Telephone Number : 440-992-8552
Fax Number : 440-992-8537
Provider Business Practice Location Address
First Line : 4726 MAIN AVE
Second Line :
City : ASHTABULA
State : OH
Zip : 44004-6929
Country : US
Telephone Number : 440-992-8552
Fax Number : 440-992-8537
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2014
Last Update Date : 09/08/2014

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Directions to “ MS. LISA LIGHT ” Practice Location

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