LISA OMO-GRIFFITH (NPI# 1629399696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629399696 |
| Entity Type | Individual |
| Full Name | LISA OMO-GRIFFITH |
| Credential | N.P. |
| Practice Address |
2520 E Dupont Rd Fort Wayne IN 46825-1675 |
| Mailing Address |
6435 W Jefferson Blvd Pmb 109 Fort Wayne IN 46804-6203 |
| Practice Telephone | 2603444035 |
| Practice Fax Number | 2609699272 |
| Mailing Telephone | 2603444035 |
| Mailing Fax Number | 2609699272 |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2016-06-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 28156677 | IN | Nursing Service Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
COA13460 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71003136 | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0069880 | 05 | |
| IN | 200999600 | 05 | |
| IN | ANTHEM | 000000682872 | 01 |
| IN | R.R. MEDICARE | P01044179 | 01 |
| Street Address |
2520 E DUPONT RD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46825-1675 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538110556 | Dupont Hospital LLC | General Acute Care Hospital | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2006-05-15 |
| 1558905364 | Kari Louise Hackley | Nurse Practitioner | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2019-11-05 |
| 1184138349 | Candace Jo Nicholas | Nurse Practitioner | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2017-11-27 |
| 1346752870 | Stacy Rose Masters | Registered Nurse | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2017-10-24 |
| 1942724547 | Doug Wesley Brady | Nurse Practitioner | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2017-07-26 |
| 1699129148 | Kimberly Mcmurray | Nurse Practitioner | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2016-04-21 |
| 1508227042 | Rachel Stephens | Dietitian, Registered | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2016-03-11 |
| 1922468651 | Jodi Selking | Dietitian, Registered | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2016-02-23 |
| 1770942427 | Rachel Griffin | Registered Nurse | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2016-02-22 |
| 1659738185 | Constance Harding | Dietitian, Registered | 2520 E Dupont Rd, Fort Wayne, IN 46825-1675 | 2016-01-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772078 | Bradley Murphy | Occupational Therapist | 2626 St Joe Center Ed, Fort Wayne, IN 46825 | 2020-02-21 |
| 1144851015 | Sabryna Roman | Developmental Therapist | 2626 St Joe Center Rd, Fort Wayne, IN 46825 | 2020-01-30 |
| 1205474103 | Ashleigh Miller | Developmental Therapist | 2626 St. Joe Center Rd, Fort Wayne, IN 46825 | 2019-12-11 |
| 1962055152 | Carehalo Ohio LLC | General Practice | 2510 Dupont Circle Dr., Suite 201, Fort Wayne, IN 46825 | 2019-07-17 |
| 1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
| 1326582925 | Mark F Stoner LLC | Dentist | 9830 Auburn Rd Suite 102, Fort Wayne, IN 46825 | 2016-12-15 |
| 1336695782 | Nadine Rene' Handy | Nurse Practitioner | 3978 New Vision Dr., Fort Wayne, IN 46825 | 2016-08-26 |
| 1558815712 | Nathan Paul Miller | Physical Therapist | 10006 Auburn Park Dr, Fort Wayne, IN 46825 | 2016-08-05 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1003276643 | Seiss, LLC | Psychologist | 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 | 2016-02-24 |
| Find all providers in zip 46825 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518566397 | Stacey Renee Pulver | Nurse Practitioner | 13134 Hollow Oak Rd, Fort Wayne, IN 46845-2327 | 2020-10-22 |
| 1649878554 | Heather Ormiston-leclear | Nurse Practitioner | 3800 N Anthony Blvd # Cc1335, Fort Wayne, IN 46805-1430 | 2020-10-13 |
| 1669081618 | Carly Ann Nahrwold | Nurse Practitioner | 7025 Old Trail Rd # 9574, Fort Wayne, IN 46809-2713 | 2020-07-27 |
| 1932725942 | Health Essential LLC | Nurse Practitioner | 3030 Lake Ave Ste 14, Fort Wayne, IN 46805-5428 | 2020-06-25 |
| 1942824842 | Carissa Miller | Nurse Practitioner | 707 Rollingwood Ln, Fort Wayne, IN 46845-1088 | 2020-06-05 |
| 1891329819 | Jasmine Monae Tubbs | Nurse Practitioner | 875 Petal Way, Fort Wayne, IN 46816-8900 | 2020-02-28 |
| 1235780362 | Elizabeth Rose Lichtsinn | Nurse Practitioner | 3919 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804-6811 | 2019-09-20 |
| 1033676275 | Amanda Warner | Nurse Practitioner | 2229 Woods Rd, Fort Wayne, IN 46818-9539 | 2019-02-25 |
| 1669940714 | Brookelyn Agler | Nurse Practitioner | Summit Radiology, PC, 5001 Us Highway 30 W, Suite D, Fort Wayne, IN 46818-9701 | 2018-11-07 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46825 |
Please comment or provide details below to improve the information on LISA OMO-GRIFFITH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.