Individual
NICHOLAS A LUISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1050 DELAWARE AVE, MARION, OH 43302-6416
(740) 375-6440
(740) 383-3040
Mailing address
5400 FRANTZ RD, SUITE 250, DUBLIN, OH 43016-4144
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50.003554
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076012
—
OH
Enumeration date
08/09/2012
Last updated
08/12/2015
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