Individual
LISA A MIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
900 S DIXIE DR, SUITE 40, VANDALIA, OH 45377-2657
(937) 890-6644
(937) 890-1726
Mailing address
900 S DIXIE DR, SUITE 40, VANDALIA, OH 45377-2657
(937) 890-6644
(937) 890-1726
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
NM05540
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2339704
—
OH
Enumeration date
04/25/2006
Last updated
11/13/2013
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