Provider Demographics
NPI:1811413081
Name:MINSHALL, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MINSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8409
Mailing Address - Country:US
Mailing Address - Phone:740-446-5500
Mailing Address - Fax:740-446-2159
Practice Address - Street 1:112 E MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:OH
Practice Address - Zip Code:45769-9569
Practice Address - Country:US
Practice Address - Phone:740-992-2192
Practice Address - Fax:740-992-4018
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator