Provider Demographics
NPI:1316231277
Name:TRICK, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:TRICK
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 1:870 S MEADOW CIR
Mailing Address - Street 2:APT 102
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-6115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8650 GOVERNORS HILL DR
Practice Address - Street 2:SUITE 108
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1372
Practice Address - Country:US
Practice Address - Phone:866-791-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03534314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility