Provider Demographics
NPI:1477615730
Name:WHITE, LISA K (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 CHEVIOT HILLS LN
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9688
Mailing Address - Country:US
Mailing Address - Phone:937-603-9962
Mailing Address - Fax:
Practice Address - Street 1:4700 E GALBRAITH RD
Practice Address - Street 2:SUITE 302
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2754
Practice Address - Country:US
Practice Address - Phone:888-393-9799
Practice Address - Fax:937-531-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08556-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2654088Medicaid
OH2654088Medicaid