Provider Demographics
NPI:1881189983
Name:MARTZ, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MARTZ
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 1:410 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-4327
Mailing Address - Country:US
Mailing Address - Phone:330-990-7543
Mailing Address - Fax:
Practice Address - Street 1:410 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-4327
Practice Address - Country:US
Practice Address - Phone:330-990-7543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty