Provider Demographics
NPI:1730366972
Name:LISTON, LISA A
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:LISTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4131
Mailing Address - Country:US
Mailing Address - Phone:513-422-7016
Mailing Address - Fax:513-422-5963
Practice Address - Street 1:1311 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-4131
Practice Address - Country:US
Practice Address - Phone:513-422-7016
Practice Address - Fax:513-422-5963
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator