Provider Demographics
NPI:1518596675
Name:DUGAN MANOR, LISA GAYLE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:DUGAN MANOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1210
Mailing Address - Country:US
Mailing Address - Phone:513-815-4475
Mailing Address - Fax:
Practice Address - Street 1:2805 GILBERT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1210
Practice Address - Country:US
Practice Address - Phone:513-815-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH422891163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH422891OtherNURSING LICENSE