Provider Demographics
NPI:1508744574
Name:DUBOSE, LISA DANIELLE
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DANIELLE
Last Name:DUBOSE
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 1:3961 GLENCROSS AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-1912
Mailing Address - Country:US
Mailing Address - Phone:513-602-5851
Mailing Address - Fax:513-829-4999
Practice Address - Street 1:3961 GLENCROSS AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-1912
Practice Address - Country:US
Practice Address - Phone:513-602-5851
Practice Address - Fax:513-829-4999
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X, 376J00000X, 374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker