Provider Demographics
NPI:1841436151
Name:WILLIAMS, LISA ANNETTE (RN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNETTE
Last Name:WILLIAMS
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 1:136 PAR VIEW DR BLDG 19
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8991
Mailing Address - Country:US
Mailing Address - Phone:740-964-9378
Mailing Address - Fax:
Practice Address - Street 1:136 PAR VIEW DR BLDG 19
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-8991
Practice Address - Country:US
Practice Address - Phone:740-964-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-230756163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse