Provider Demographics
NPI:1740449214
Name:STRAIGHT, LISA JO (RNCS-FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JO
Last Name:STRAIGHT
Suffix:
Gender:F
Credentials:RNCS-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-0373
Mailing Address - Country:US
Mailing Address - Phone:304-643-4005
Mailing Address - Fax:304-643-4007
Practice Address - Street 1:135 S PENN AVE
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362
Practice Address - Country:US
Practice Address - Phone:304-643-4005
Practice Address - Fax:304-643-4007
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV036970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7105043000Medicaid
S74170Medicare UPIN
WV7105043000Medicaid