Provider Demographics
NPI:1639302425
Name:NIEHAUS, LISA (CNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:NIEHAUS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 RED BANK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2176
Mailing Address - Country:US
Mailing Address - Phone:513-272-0313
Mailing Address - Fax:513-272-0316
Practice Address - Street 1:4440 RED BANK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2176
Practice Address - Country:US
Practice Address - Phone:513-272-0313
Practice Address - Fax:513-272-0316
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10916-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3014026Medicaid
OH3014026Medicaid