Provider Demographics
NPI:1548461593
Name:BLUE, LISHA MICHELE (CNP)
Entity type:Individual
Prefix:
First Name:LISHA
Middle Name:MICHELE
Last Name:BLUE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:P.O. BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:135 N EWING ST
Practice Address - Street 2:SUITE 302
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3382
Practice Address - Country:US
Practice Address - Phone:740-689-6430
Practice Address - Fax:740-689-6431
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health