Provider Demographics
NPI:1750678314
Name:KING, LISA G (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:G
Last Name:KING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:807 SOUTHWESTERN RUN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3688
Mailing Address - Country:US
Mailing Address - Phone:330-729-0059
Mailing Address - Fax:330-729-9297
Practice Address - Street 1:807 SOUTHWESTERN RUN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3688
Practice Address - Country:US
Practice Address - Phone:330-729-0059
Practice Address - Fax:330-729-9297
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHRN169199163WN0300X
OHPENDING364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WN0300XNursing Service ProvidersRegistered NurseNephrology