Provider Demographics
NPI:1376188425
Name:LISK, CHELSEA JOLINE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:JOLINE
Last Name:LISK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:JOLINE
Other - Last Name:SEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:332 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1932
Mailing Address - Country:US
Mailing Address - Phone:330-369-9947
Mailing Address - Fax:
Practice Address - Street 1:7067 TIFFANY BLVD STE 280
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1803
Practice Address - Country:US
Practice Address - Phone:330-227-8496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH025663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily