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Individual

LISA M MOORMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
3050 MACK RD STE 300, FAIRFIELD, OH 45014-5376
(513) 751-2145
Mailing address
5053 WOOSTER RD, CINCINNATI, OH 45226-2326
(513) 751-2145
(513) 751-1848

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
07397-NP
OH
363L00000X
Nurse Practitioner
1102028
KY
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN.CNP.07397
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200444510
IN
05
3059596
OH
05
78010451
KY
Enumeration date
04/19/2006
Last updated
04/19/2021
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