Provider Demographics
NPI:1194024182
Name:CARTER, LISA CHARLENE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHARLENE
Last Name:CARTER
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 1:6956 ONYXBLUFF LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8099
Mailing Address - Country:US
Mailing Address - Phone:614-599-0304
Mailing Address - Fax:614-759-3486
Practice Address - Street 1:6956 ONYXBLUFF LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8099
Practice Address - Country:US
Practice Address - Phone:614-599-0304
Practice Address - Fax:614-759-3486
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-077793-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse