Provider Demographics
NPI:1043348527
Name:GRANT, LISA (FNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:GRANT
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 1:31 EGYPT LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:ME
Mailing Address - Zip Code:04634-3008
Mailing Address - Country:US
Mailing Address - Phone:207-460-3285
Mailing Address - Fax:
Practice Address - Street 1:10 WAYMAN LN
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1625
Practice Address - Country:US
Practice Address - Phone:207-288-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP36939Medicare UPIN