Provider Demographics
NPI:1992104582
Name:KLINEBRIEL, LISA
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KLINEBRIEL
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 1:1631 WELLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8458
Mailing Address - Country:US
Mailing Address - Phone:812-406-9338
Mailing Address - Fax:
Practice Address - Street 1:1631 WELLINGTON WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8458
Practice Address - Country:US
Practice Address - Phone:812-406-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN121303164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse