Provider Demographics
NPI:1124373816
Name:GOINS, LISA (PHD APRN FNP-BC RMT)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:GOINS
Suffix:
Gender:F
Credentials:PHD APRN FNP-BC RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-1306
Mailing Address - Country:US
Mailing Address - Phone:513-857-5679
Mailing Address - Fax:
Practice Address - Street 1:201 N BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1306
Practice Address - Country:US
Practice Address - Phone:513-857-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13621-NP363LF0000X
KY3008409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2926427Medicaid
OH2926427Medicaid