Provider Demographics
NPI:1275216442
Name:GHEEN, LISA K
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:GHEEN
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 1:114 TRANQUILITY DR
Mailing Address - Street 2:
Mailing Address - City:CAPON BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711-8914
Mailing Address - Country:US
Mailing Address - Phone:540-550-0980
Mailing Address - Fax:
Practice Address - Street 1:114 TRANQUILITY DR
Practice Address - Street 2:
Practice Address - City:CAPON BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711-8914
Practice Address - Country:US
Practice Address - Phone:540-550-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant