Provider Demographics
NPI:1285239624
Name:KINZER, LISA ROSE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROSE
Last Name:KINZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4869 MEADOWGROVE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:OH
Mailing Address - Zip Code:43112-9588
Mailing Address - Country:US
Mailing Address - Phone:636-734-0440
Mailing Address - Fax:
Practice Address - Street 1:4869 MEADOWGROVE DR
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9588
Practice Address - Country:US
Practice Address - Phone:636-734-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide