Provider Demographics
NPI:1548862402
Name:BRANT, LISA RENEE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENEE
Last Name:BRANT
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 1:900 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9443
Mailing Address - Country:US
Mailing Address - Phone:567-224-6604
Mailing Address - Fax:
Practice Address - Street 1:900 TAMARACK DR
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9443
Practice Address - Country:US
Practice Address - Phone:567-224-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70042963747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant