Provost, Lisa Ann

Provost, Lisa Ann is an sole proprietor health care provider with primary practice located at 401 Matthew St , Marietta OH 45750-1635. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Provost, Lisa Ann can be contacted via phone (740) 376-1994.

Contact Information

Primary practice address
401 Matthew St Marietta OH 45750-1635
Phone: (740) 376-1994
Fax: (740) 376-1940
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 3485A Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X COA.04992-NA Ohio

Profile Details

NPI number 1235106840
LBN Legal business name Provost, Lisa Ann
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 2nd, 2006
Last updated Dec 13th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235106840 NPPES
West Virginia MEDICAID 0069080000
West Virginia MEDICAID 0282617
West Virginia MEDICAID 74472408
West Virginia Other 000000339679

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