Provider Demographics
NPI:1447534466
Name:KEBLISH, LISA RENEE (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:KEBLISH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3732
Mailing Address - Country:US
Mailing Address - Phone:425-417-9531
Mailing Address - Fax:
Practice Address - Street 1:1304 IDAHO AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3732
Practice Address - Country:US
Practice Address - Phone:425-417-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN618600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse