Provider Demographics
NPI:1922389337
Name:WAHOFF, LISA ANN (CNP, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:WAHOFF
Suffix:
Gender:F
Credentials:CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3713
Mailing Address - Country:US
Mailing Address - Phone:614-488-5794
Mailing Address - Fax:614-488-5727
Practice Address - Street 1:946 PALMER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3713
Practice Address - Country:US
Practice Address - Phone:614-488-5794
Practice Address - Fax:614-488-5727
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA12585NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health