Provider Demographics
NPI:1063651461
Name:KNISKA, LISA LYNN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:KNISKA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 STUTZ DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9155
Mailing Address - Country:US
Mailing Address - Phone:330-259-0440
Mailing Address - Fax:330-259-0441
Practice Address - Street 1:3685 STUTZ DR STE 101
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9155
Practice Address - Country:US
Practice Address - Phone:330-259-0440
Practice Address - Fax:330-259-0441
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP10260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398314Medicaid
OHNA0456401Medicare PIN
OHA77958Medicare UPIN