Provider Demographics
NPI:1750399333
Name:CROSBY, LISA K (CNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:CROSBY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MACK RD.
Mailing Address - Street 2:ML 11032
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5379
Mailing Address - Country:US
Mailing Address - Phone:513-636-8259
Mailing Address - Fax:513-636-6419
Practice Address - Street 1:3050 MACK RD.
Practice Address - Street 2:ML 11032
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5379
Practice Address - Country:US
Practice Address - Phone:513-636-8259
Practice Address - Fax:513-636-6419
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.02362363L00000X
OHCOA.02362-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care