Provider Demographics
NPI:1003898677
Name:ENO, LISA M (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ENO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743
Mailing Address - Country:US
Mailing Address - Phone:207-834-6784
Mailing Address - Fax:207-834-2967
Practice Address - Street 1:197 EAST MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743
Practice Address - Country:US
Practice Address - Phone:207-834-6784
Practice Address - Fax:207-834-2967
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081368363LF0000X
MER034632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME999010617Medicaid
D46407OtherANTHEM
ME266740099Medicaid
ME266740099Medicaid
ME999010617Medicaid