Provider Demographics
NPI:1033546643
Name:SALISBURY, LISA ANN (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:GIRAMONTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 WASON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1381
Mailing Address - Country:US
Mailing Address - Phone:413-241-2100
Mailing Address - Fax:413-735-2012
Practice Address - Street 1:100 WASON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1381
Practice Address - Country:US
Practice Address - Phone:413-241-2100
Practice Address - Fax:413-735-2012
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4740363A00000X
CT002873363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant