Provider Demographics
NPI:1003047465
Name:HEISER, LISA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:HEISER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 BIBICH CT
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1815
Mailing Address - Country:US
Mailing Address - Phone:419-569-5567
Mailing Address - Fax:
Practice Address - Street 1:1045 BIBICH CT
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1815
Practice Address - Country:US
Practice Address - Phone:419-569-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 347138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse