Provider Demographics
NPI:1003116906
Name:NETTER, LISA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:NETTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 BLEECKER LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45225-1703
Mailing Address - Country:US
Mailing Address - Phone:513-238-5968
Mailing Address - Fax:
Practice Address - Street 1:1767 BLEECKER LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45225-1703
Practice Address - Country:US
Practice Address - Phone:513-238-5968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 124643-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse