Provider Demographics
NPI:1912188012
Name:DOUGLASS, LOIS CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:CHRISTINE
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7724 AULT RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44645-9727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7724 AULT RD
Practice Address - Street 2:
Practice Address - City:MARSHALLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44645-9727
Practice Address - Country:US
Practice Address - Phone:330-855-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily