Provider Demographics
NPI:1932699436
Name:LANSBERRY, LISHA ANNETTE-KATHLEEN (APRN)
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:ANNETTE-KATHLEEN
Last Name:LANSBERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LISHA
Other - Middle Name:
Other - Last Name:TAEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:420 HAMMET RD
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5061
Mailing Address - Country:US
Mailing Address - Phone:401-440-1761
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:401-440-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134397363LN0000X
OH022685363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care