Provider Demographics
NPI:1407489909
Name:GATTEN, LISA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:GATTEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HOLSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719-0054
Mailing Address - Country:US
Mailing Address - Phone:740-359-2478
Mailing Address - Fax:
Practice Address - Street 1:223 LAKE ST # 54
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:OH
Practice Address - Zip Code:43719-7532
Practice Address - Country:US
Practice Address - Phone:740-359-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62047163W00000X
OHRN224062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse