Provider Demographics
NPI:1740866771
Name:OVERSTREET, LISA A
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 ANSEL RD APT 931
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4172
Mailing Address - Country:US
Mailing Address - Phone:216-507-2467
Mailing Address - Fax:
Practice Address - Street 1:1675 ANSEL RD APT 931
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4172
Practice Address - Country:US
Practice Address - Phone:216-507-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty