Provider Demographics
NPI:1598092710
Name:RHODES, LISA A (CNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:RHODES
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 1:11312 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-9580
Mailing Address - Country:US
Mailing Address - Phone:937-272-3659
Mailing Address - Fax:937-237-4776
Practice Address - Street 1:2912 SPRINGBORO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1674
Practice Address - Country:US
Practice Address - Phone:937-297-8999
Practice Address - Fax:937-237-4776
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP - 11105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH421534506158OtherCARESOURCE
OH000000637741OtherBCBS-OH
OH3016846Medicaid
OH000000637741OtherBCBS-OH