Provider Demographics
NPI:1417394248
Name:GREGORY, LISA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 WILLOWPARK CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9298
Mailing Address - Country:US
Mailing Address - Phone:614-832-6639
Mailing Address - Fax:
Practice Address - Street 1:1704 WILLOWPARK CT
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9298
Practice Address - Country:US
Practice Address - Phone:614-832-6639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-092931-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse