Provider Demographics
NPI:1669601696
Name:PETERMAN, LISA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-3242
Mailing Address - Country:US
Mailing Address - Phone:330-219-8764
Mailing Address - Fax:
Practice Address - Street 1:338 OHIO AVE
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-3242
Practice Address - Country:US
Practice Address - Phone:330-219-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 119525 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse