Provider Demographics
NPI:1316158264
Name:GHERE, LISA R
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:GHERE
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 1:3214 HIDDEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9786
Mailing Address - Country:US
Mailing Address - Phone:316-282-2288
Mailing Address - Fax:316-282-2288
Practice Address - Street 1:3214 HIDDEN MEADOW DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9786
Practice Address - Country:US
Practice Address - Phone:316-282-2288
Practice Address - Fax:316-282-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100354280AMedicaid