Individual
LISA MARIE SCAVNICKY-MAMULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1040 SAPPHIRE FLAME CT, DELAWARE, OH 43015-5088
(740) 816-6954
Mailing address
1040 SAPPHIRE FLAME CT, DELAWARE, OH 43015-5088
(740) 816-6954
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3002533-03
TRICARE SELECT
OH
Enumeration date
10/25/2022
Last updated
10/25/2022
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