Provider Demographics
NPI:1487827671
Name:BOISSELLE, LISA JANET (DPH, CGP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANET
Last Name:BOISSELLE
Suffix:
Gender:F
Credentials:DPH, CGP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:JANET
Other - Last Name:BARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2813 EATON DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2269
Mailing Address - Country:US
Mailing Address - Phone:405-210-5681
Mailing Address - Fax:
Practice Address - Street 1:2813 EATON DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2269
Practice Address - Country:US
Practice Address - Phone:405-210-5681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist