Provider Demographics
NPI:1427610492
Name:MAHONE, LISA MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:MAHONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HENNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3600 KOLBE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-960-3954
Mailing Address - Fax:440-960-3956
Practice Address - Street 1:3600 KOLBE RD STE 106
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-960-3954
Practice Address - Fax:440-960-3956
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily