Provider Demographics
NPI:1780199182
Name:GRIFFIN, LISA DIONE (STNA)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:DIONE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S BECKER RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45887-9502
Mailing Address - Country:US
Mailing Address - Phone:419-296-6898
Mailing Address - Fax:
Practice Address - Street 1:517 S SHORE DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-1159
Practice Address - Country:US
Practice Address - Phone:567-289-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401902221016251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401902221016Medicaid