Provider Demographics
NPI:1003905365
Name:SITES, LISA LYNN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:LYNN
Last Name:SITES
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 1:2675 TOWNSHIP ROAD 167
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9793
Mailing Address - Country:US
Mailing Address - Phone:419-864-3271
Mailing Address - Fax:
Practice Address - Street 1:7555 TOWNSHIP ROAD 58
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9797
Practice Address - Country:US
Practice Address - Phone:419-946-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH102828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2171546Medicare UPIN