Provider Demographics
NPI:1700082815
Name:TIRADO, LISA K (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:TIRADO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 BELLFONTAINE RD
Mailing Address - Street 2:
Mailing Address - City:HARROD
Mailing Address - State:OH
Mailing Address - Zip Code:45850-9708
Mailing Address - Country:US
Mailing Address - Phone:567-204-0873
Mailing Address - Fax:
Practice Address - Street 1:712 DOUGLAS ST
Practice Address - Street 2:APT G
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5553
Practice Address - Country:US
Practice Address - Phone:567-204-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA173154163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse