Provider Demographics
NPI:1154297067
Name:HETRICK, LISA L (DODD IP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:HETRICK
Suffix:
Gender:F
Credentials:DODD IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2820
Mailing Address - Country:US
Mailing Address - Phone:419-260-6862
Mailing Address - Fax:
Practice Address - Street 1:256 S GROVE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2820
Practice Address - Country:US
Practice Address - Phone:419-260-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker