Provider Demographics
NPI:1720203748
Name:BOWERSMITH, LISA ANN (HHA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BOWERSMITH
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 CALEDONIA ASHLEY RD
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9406
Mailing Address - Country:US
Mailing Address - Phone:419-864-3451
Mailing Address - Fax:
Practice Address - Street 1:107 W 2ND ST
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-1080
Practice Address - Country:US
Practice Address - Phone:419-864-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK039329374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide