Provider Demographics
NPI:1306715628
Name:BRISTEL, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRISTEL
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 1:6929 ELLEN BOAT LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7913
Mailing Address - Country:US
Mailing Address - Phone:614-373-8085
Mailing Address - Fax:
Practice Address - Street 1:6929 ELLEN BOAT LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7913
Practice Address - Country:US
Practice Address - Phone:614-373-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2755013251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health