Provider Demographics
NPI:1922992205
Name:BAILEY-KOVACH, LISA MARIE
Entity type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:
Last Name:BAILEY-KOVACH
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 1:7164 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5026
Mailing Address - Country:US
Mailing Address - Phone:440-221-2912
Mailing Address - Fax:
Practice Address - Street 1:7164 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5026
Practice Address - Country:US
Practice Address - Phone:440-221-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker