Provider Demographics
NPI:1861872251
Name:COLLINS, LISA (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:COLLINS
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 1:633 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47390-1131
Mailing Address - Country:US
Mailing Address - Phone:937-459-6819
Mailing Address - Fax:
Practice Address - Street 1:633 N UNION ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:IN
Practice Address - Zip Code:47390-1131
Practice Address - Country:US
Practice Address - Phone:937-459-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.104422-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse