Provider Demographics
NPI:1780286880
Name:HART, LISA MARIE (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HART
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 1:6279 STATE ROUTE 97
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-9604
Mailing Address - Country:US
Mailing Address - Phone:419-262-1380
Mailing Address - Fax:
Practice Address - Street 1:6279 STATE ROUTE 97
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9604
Practice Address - Country:US
Practice Address - Phone:419-262-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care