Provider Demographics
NPI:1710376736
Name:PUGELY, LISA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:PUGELY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:PUGELY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:9906 W PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6009
Mailing Address - Country:US
Mailing Address - Phone:440-885-8663
Mailing Address - Fax:440-885-8664
Practice Address - Street 1:9906 W PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-6009
Practice Address - Country:US
Practice Address - Phone:440-885-8663
Practice Address - Fax:440-885-8664
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.394885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse