Provider Demographics
NPI:1548045594
Name:NUNEZ, LISA M (DSP, IP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:DSP, IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-3071
Mailing Address - Country:US
Mailing Address - Phone:216-553-2270
Mailing Address - Fax:
Practice Address - Street 1:4330 W 130TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-3071
Practice Address - Country:US
Practice Address - Phone:121-655-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372500000X, 3747A0650X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider