Provider Demographics
NPI:1255858106
Name:WALDRON, LISA LYNN (HHA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LYNN
Last Name:WALDRON
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 FALLSBURG RD
Mailing Address - Street 2:
Mailing Address - City:FRAZEYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43822-9567
Mailing Address - Country:US
Mailing Address - Phone:740-616-6073
Mailing Address - Fax:
Practice Address - Street 1:11481 FALLSBURG RD
Practice Address - Street 2:
Practice Address - City:FRAZEYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43822-9567
Practice Address - Country:US
Practice Address - Phone:740-616-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide