Provider Demographics
NPI:1164450474
Name:SCUDDER-MARKER, LISA (APRN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:SCUDDER-MARKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28100 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4522
Mailing Address - Country:US
Mailing Address - Phone:216-831-1466
Mailing Address - Fax:
Practice Address - Street 1:28100 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4522
Practice Address - Country:US
Practice Address - Phone:216-831-1466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048222-23-03363L00000X
OHAPRN.CNP.16903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0NP3290Medicaid
NH30341527Medicaid
NH30341527Medicaid
VT0NP3290Medicaid