Provider Demographics
NPI:1780964718
Name:KELLEY-MATTHEWS, LISBETH (BSN,RN)
Entity type:Individual
Prefix:MRS
First Name:LISBETH
Middle Name:
Last Name:KELLEY-MATTHEWS
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 TIMES SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7101
Mailing Address - Country:US
Mailing Address - Phone:614-353-5214
Mailing Address - Fax:614-754-5086
Practice Address - Street 1:4196 TIMES SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7101
Practice Address - Country:US
Practice Address - Phone:614-353-5214
Practice Address - Fax:614-754-5086
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH258508163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health