Provider Demographics
NPI:1669855987
Name:NEEB, LISA (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:NEEB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1122 TUPPER LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-1162
Mailing Address - Country:US
Mailing Address - Phone:616-755-0938
Mailing Address - Fax:616-374-1067
Practice Address - Street 1:1122 TUPPER LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1162
Practice Address - Country:US
Practice Address - Phone:616-755-0938
Practice Address - Fax:616-374-1067
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703094902164W00000X
372600000X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker