Provider Demographics
NPI:1184020810
Name:OLIVER, LISA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:OLIVER
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 1:15655 STATE ROUTE 170 STE A
Mailing Address - Street 2:
Mailing Address - City:CALCUTTA
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9672
Mailing Address - Country:US
Mailing Address - Phone:330-386-4303
Mailing Address - Fax:216-229-2630
Practice Address - Street 1:15655 STATE ROUTE 170 STE A
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9672
Practice Address - Country:US
Practice Address - Phone:330-386-4303
Practice Address - Fax:216-229-2630
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019377363LF0000X
PARN630490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse