Provider Demographics
NPI:1174668073
Name:HAUPT, LISHA LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISHA
Middle Name:LYNN
Last Name:HAUPT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17242 WOLFE RD
Mailing Address - Street 2:
Mailing Address - City:LAURELVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43135
Mailing Address - Country:US
Mailing Address - Phone:740-332-4287
Mailing Address - Fax:740-332-4287
Practice Address - Street 1:17242 WOLFE RD
Practice Address - Street 2:
Practice Address - City:LAURELVILLE
Practice Address - State:OH
Practice Address - Zip Code:43135
Practice Address - Country:US
Practice Address - Phone:740-332-4287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH327230163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134658Medicaid