Provider Demographics
NPI:1427292903
Name:HAASTRUP, LILLIAN MONISOLA (PMHCNS-BC)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:MONISOLA
Last Name:HAASTRUP
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:MONISOLA
Other - Last Name:IDOWU-OGINNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2200 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1297
Mailing Address - Country:US
Mailing Address - Phone:614-752-0333
Mailing Address - Fax:614-752-0383
Practice Address - Street 1:2200 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1297
Practice Address - Country:US
Practice Address - Phone:614-752-0333
Practice Address - Fax:614-752-0383
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 341630163WG0000X
OHRN341630163WP0808X
OHNS-15433364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH315790Medicare PIN