Provider Demographics
NPI:1386875458
Name:HISSONG, LISA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HISSONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 STERLING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3957
Mailing Address - Country:US
Mailing Address - Phone:614-579-7866
Mailing Address - Fax:
Practice Address - Street 1:44 STERLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3957
Practice Address - Country:US
Practice Address - Phone:614-579-7866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 123198-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse