Provider Demographics
NPI:1710187679
Name:HACKETT, LISA ADELE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ADELE
Last Name:HACKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 GLENDON CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3246
Mailing Address - Country:US
Mailing Address - Phone:614-889-7561
Mailing Address - Fax:614-889-7648
Practice Address - Street 1:4043 AYSHIRE CT
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7764
Practice Address - Country:US
Practice Address - Phone:614-889-7561
Practice Address - Fax:614-889-7648
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN - 217005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse