Provider Demographics
NPI:1992184964
Name:DREW, LISA M (PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:DREW
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 ELTON ST
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1769
Mailing Address - Country:US
Mailing Address - Phone:734-756-6679
Mailing Address - Fax:
Practice Address - Street 1:40 ELTON ST
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1769
Practice Address - Country:US
Practice Address - Phone:313-409-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2022-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5157600OtherSEMI INDEPENDENT ROOMING HOUSE
MI5157600OtherHOME CHORE SERVICE WORKER