Provider Demographics
NPI:1881384303
Name:COURGIS, LISA (LPN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:COURGIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 W GREEN ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2091
Mailing Address - Country:US
Mailing Address - Phone:732-966-2358
Mailing Address - Fax:
Practice Address - Street 1:6111 OAK TREE BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2589
Practice Address - Country:US
Practice Address - Phone:800-897-9177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05101300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse