Provider Demographics
NPI:1194015263
Name:EMERSON, LISA BERNICE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BERNICE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 JONES RD
Mailing Address - Street 2:
Mailing Address - City:NASHPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43830-9700
Mailing Address - Country:US
Mailing Address - Phone:740-704-6644
Mailing Address - Fax:
Practice Address - Street 1:7215 JONES RD
Practice Address - Street 2:
Practice Address - City:NASHPORT
Practice Address - State:OH
Practice Address - Zip Code:43830-9700
Practice Address - Country:US
Practice Address - Phone:740-704-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse