Provider Demographics
NPI:1174397186
Name:HASH, LISA MARIE (AGNP-BC)
Entity type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:
Last Name:HASH
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23465 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-4863
Mailing Address - Country:US
Mailing Address - Phone:586-859-1443
Mailing Address - Fax:
Practice Address - Street 1:23465 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-4863
Practice Address - Country:US
Practice Address - Phone:586-859-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704336724363L00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner