Provider Demographics
NPI:1619414174
Name:WOOD, LISA (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FREID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:404 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1684
Mailing Address - Country:US
Mailing Address - Phone:513-468-9308
Mailing Address - Fax:
Practice Address - Street 1:1659 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6705
Practice Address - Country:US
Practice Address - Phone:513-424-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.424310163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health