Provider Demographics
NPI:1700033404
Name:CAROLAN-KATZ, LISA MARIE (ACNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CAROLAN-KATZ
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN STREET
Mailing Address - Street 2:SUITE M124
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7500
Mailing Address - Fax:269-341-7540
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:SUITE 4490
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-5287
Practice Address - Fax:937-208-5292
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN321469363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3022062Medicaid
OHNP33973Medicare PIN
OH3022062Medicaid