Provider Demographics
NPI:1407357502
Name:KOHELER, LISA WARD
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:WARD
Last Name:KOHELER
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 1:14165 MELODY DR
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-3251
Mailing Address - Country:US
Mailing Address - Phone:443-944-7011
Mailing Address - Fax:
Practice Address - Street 1:909 PROGRESS CIR STE 100
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2324
Practice Address - Country:US
Practice Address - Phone:410-742-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator