Provider Demographics
NPI:1508118324
Name:HINMAN, LISA J (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:HINMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SOLVAY
Mailing Address - State:NY
Mailing Address - Zip Code:13209-2160
Mailing Address - Country:US
Mailing Address - Phone:315-432-5636
Mailing Address - Fax:
Practice Address - Street 1:111 WORTH AVE
Practice Address - Street 2:
Practice Address - City:SOLVAY
Practice Address - State:NY
Practice Address - Zip Code:13209-2160
Practice Address - Country:US
Practice Address - Phone:315-432-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288443164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse