Provider Demographics
NPI:1487113312
Name:WILSON, LISA DARNELL (FNP-C)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:DARNELL
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 EDEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-6005
Mailing Address - Country:US
Mailing Address - Phone:513-246-9155
Mailing Address - Fax:513-487-4331
Practice Address - Street 1:625 EDEN PARK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6005
Practice Address - Country:US
Practice Address - Phone:513-246-9155
Practice Address - Fax:513-487-4331
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily