Provider Demographics
NPI:1326247560
Name:CAVINS, LISA RENEE' (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE'
Last Name:CAVINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE'
Other - Last Name:HAYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:2012 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2149
Mailing Address - Country:US
Mailing Address - Phone:937-342-9924
Mailing Address - Fax:
Practice Address - Street 1:2012 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2149
Practice Address - Country:US
Practice Address - Phone:937-342-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN332226163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse