Provider Demographics
NPI:1245565365
Name:BROUN, LISA ANN (CNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BROUN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:LONGSHORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4777 E GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2725
Mailing Address - Country:US
Mailing Address - Phone:513-686-3011
Mailing Address - Fax:513-686-5649
Practice Address - Street 1:4777 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2725
Practice Address - Country:US
Practice Address - Phone:513-686-3011
Practice Address - Fax:513-686-5649
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRX10715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner