Provider Demographics
NPI:1043222441
Name:LONSDALE, ELIZABETH M (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:LONSDALE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1823
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1823
Mailing Address - Country:US
Mailing Address - Phone:207-755-3715
Mailing Address - Fax:207-755-3728
Practice Address - Street 1:45 GOLDER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6033
Practice Address - Country:US
Practice Address - Phone:207-755-3715
Practice Address - Fax:207-755-3728
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER030096367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME306190099Medicaid
430035517OtherRAILROAD MEDICARE
430035517OtherRAILROAD MEDICARE