Provider Demographics
NPI:1043695919
Name:BARAN, LISA M (LPN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:BARAN
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 1:8418 SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-9755
Mailing Address - Country:US
Mailing Address - Phone:315-406-9048
Mailing Address - Fax:
Practice Address - Street 1:8418 SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-9755
Practice Address - Country:US
Practice Address - Phone:315-406-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264553164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse