Provider Demographics
NPI:1396963013
Name:DUFFLEY-KAZMIERSKI, LISA ANTOINETTE (DT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANTOINETTE
Last Name:DUFFLEY-KAZMIERSKI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12610 HAVENWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8692
Mailing Address - Country:US
Mailing Address - Phone:219-757-1086
Mailing Address - Fax:219-374-6583
Practice Address - Street 1:12610 HAVENWOOD PASS
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-8692
Practice Address - Country:US
Practice Address - Phone:219-757-1086
Practice Address - Fax:219-374-6583
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider