Provider Demographics
NPI:1285858241
Name:AICHHOLZ, LISA JO (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JO
Last Name:AICHHOLZ
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 1:202 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44854-9703
Mailing Address - Country:US
Mailing Address - Phone:419-492-3334
Mailing Address - Fax:
Practice Address - Street 1:1400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9088
Practice Address - Country:US
Practice Address - Phone:419-483-4040
Practice Address - Fax:419-483-1307
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2606399Medicaid