Provider Demographics
NPI:1750836565
Name:HOWARD, META LISA (CNP)
Entity Type:Individual
Prefix:
First Name:META
Middle Name:LISA
Last Name:HOWARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3359 KEMP RD
Mailing Address - Street 2:SUITE 250 B
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2565
Mailing Address - Country:US
Mailing Address - Phone:937-458-4650
Mailing Address - Fax:937-458-4659
Practice Address - Street 1:3359 KEMP RD
Practice Address - Street 2:SUITE 250 B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2565
Practice Address - Country:US
Practice Address - Phone:937-458-4650
Practice Address - Fax:937-458-4659
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.19005-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181344Medicaid
OHH519980Medicare PIN