Provider Demographics
NPI:1962009233
Name:HOLSINGER-TAYLOR, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HOLSINGER-TAYLOR
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 1:5623 BUCKNECK RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45308-9427
Mailing Address - Country:US
Mailing Address - Phone:937-572-8893
Mailing Address - Fax:
Practice Address - Street 1:5623 BUCKNECK RD
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:OH
Practice Address - Zip Code:45308-9427
Practice Address - Country:US
Practice Address - Phone:937-572-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0299285Medicaid