Provider Demographics
NPI:1467955872
Name:CARNEGIS, LISA M (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CARNEGIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:HAUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45316-0020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:65 NORTH ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:OH
Practice Address - Zip Code:45316
Practice Address - Country:US
Practice Address - Phone:309-826-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.429483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.429483OtherREGISTERED NURSE LICENSE