Provider Demographics
NPI:1134601776
Name:MARKLEY, LISA LYNN
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:WEIRETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:203 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4208
Mailing Address - Country:US
Mailing Address - Phone:765-973-9200
Mailing Address - Fax:765-973-9233
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4208
Practice Address - Country:US
Practice Address - Phone:765-973-9200
Practice Address - Fax:765-973-9233
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.008817124Q00000X
FLDH17949124Q00000X
IN13003907A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist