Provider Demographics
NPI:1073345468
Name:POPE, LISA SIMONE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SIMONE
Last Name:POPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4090 E 175TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2222
Mailing Address - Country:US
Mailing Address - Phone:216-609-5027
Mailing Address - Fax:
Practice Address - Street 1:4090 E 175TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2222
Practice Address - Country:US
Practice Address - Phone:216-609-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide