Provider Demographics
NPI:1821257734
Name:HACHEY, LISA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HACHEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 MONROE ST
Mailing Address - Street 2:SUITE 8E
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2263
Mailing Address - Country:US
Mailing Address - Phone:419-517-1380
Mailing Address - Fax:419-517-1381
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:SUITE 4E&F
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4380
Practice Address - Fax:313-993-0692
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM05428364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2474639Medicaid
OHP11063Medicare UPIN