Provider Demographics
NPI:1427389584
Name:LINN, LISA ANN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:LINN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 TROY SIDNEY RD
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9215
Mailing Address - Country:US
Mailing Address - Phone:937-418-8528
Mailing Address - Fax:
Practice Address - Street 1:5715 TROY SIDNEY RD
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9215
Practice Address - Country:US
Practice Address - Phone:937-418-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH204081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse