Provider Demographics
NPI:1639458912
Name:MINOR, LISA LLOYD (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LLOYD
Last Name:MINOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:331 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1370
Mailing Address - Country:US
Mailing Address - Phone:734-223-8332
Mailing Address - Fax:
Practice Address - Street 1:500 S CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8971
Practice Address - Country:US
Practice Address - Phone:614-552-0061
Practice Address - Fax:614-552-0168
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH329456367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered