Provider Demographics
NPI:1639768146
Name:CROSS, LYSHAE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LYSHAE
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 WARRENSVILLE CENTER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5227
Mailing Address - Country:US
Mailing Address - Phone:216-882-3165
Mailing Address - Fax:
Practice Address - Street 1:3461 WARRENSVILLE CENTER RD STE 203
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5227
Practice Address - Country:US
Practice Address - Phone:216-882-3165
Practice Address - Fax:216-712-4746
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800944-S101YM0800X
OHRN-455717133NN1002X, 163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WH0200XNursing Service ProvidersRegistered NurseHome Health