Provider Demographics
NPI:1386194314
Name:OHM, LISA ROSE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROSE
Last Name:OHM
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 1:1480 LONG GROVE DR UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7103
Mailing Address - Country:US
Mailing Address - Phone:440-396-6913
Mailing Address - Fax:
Practice Address - Street 1:1480 LONG GROVE DR UNIT 104
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7103
Practice Address - Country:US
Practice Address - Phone:440-396-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236695163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health