Provider Demographics
NPI:1528335247
Name:CARPENTER, LISA L (MSN, CNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MSN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ARCH ST
Mailing Address - Street 2:STE. G2
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-375-4100
Mailing Address - Fax:330-375-4097
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:STE. G2
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-375-4100
Practice Address - Fax:330-375-4097
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP12930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057728Medicaid
OH0057728Medicaid