Provider Demographics
NPI:1952573198
Name:WRIGHT, LISA GALE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GALE
Last Name:WRIGHT
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 1:7326 STATE ROUTE 19 UNIT 2909
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9496
Mailing Address - Country:US
Mailing Address - Phone:419-688-2500
Mailing Address - Fax:
Practice Address - Street 1:7326 STATE ROUTE 19 UNIT 2909
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9496
Practice Address - Country:US
Practice Address - Phone:419-688-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN089614164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157731Medicaid