Provider Demographics
NPI:1386283109
Name:OPENSHAW, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OPENSHAW
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 1:6135 LAKESIDE DR STE 127
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-8505
Mailing Address - Country:US
Mailing Address - Phone:775-453-1644
Mailing Address - Fax:
Practice Address - Street 1:1229 ROBIN DR
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2439
Practice Address - Country:US
Practice Address - Phone:619-851-2791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide