Provider Demographics
NPI:1235431867
Name:MAYLE, LISA LYNETTE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNETTE
Last Name:MAYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3282 NEWGARDEN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9568
Mailing Address - Country:US
Mailing Address - Phone:330-314-2631
Mailing Address - Fax:
Practice Address - Street 1:3282 NEWGARDEN RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9568
Practice Address - Country:US
Practice Address - Phone:330-314-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN129867 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse