Provider Demographics
NPI:1205409869
Name:SHISHLO, LANA (CNP)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:SHISHLO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 PRINGLE BENJAMIN RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-8870
Mailing Address - Country:US
Mailing Address - Phone:614-657-5226
Mailing Address - Fax:
Practice Address - Street 1:453 WATERBURY CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5309
Practice Address - Country:US
Practice Address - Phone:614-515-5244
Practice Address - Fax:614-515-5244
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377505163W00000X
OHLE-00037609363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse