Provider Demographics
NPI:1003069782
Name:ROEDER, LISA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ROEDER
Suffix:
Gender:F
Credentials:CRNA
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Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE., ML 2001
Mailing Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4408
Mailing Address - Fax:513-636-7337
Practice Address - Street 1:3333 BURNET AVE., ML 2001
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4408
Practice Address - Fax:513-636-7337
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN.313113367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered