Provider Demographics
NPI:1487459996
Name:BIGGS, LISA JO
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JO
Last Name:BIGGS
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-0022
Mailing Address - Country:US
Mailing Address - Phone:812-361-0344
Mailing Address - Fax:
Practice Address - Street 1:3001 COUGAR DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-5432
Practice Address - Country:US
Practice Address - Phone:812-361-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN25-018612-13747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN25-018612-1OtherPSA LICENSE NUMBER