Provider Demographics
NPI:1053465328
Name:CHISM FRAINE, LISA MARIE MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:LISA MARIE
Middle Name:MARIE
Last Name:CHISM FRAINE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CHISM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-644-0274
Practice Address - Street 1:780 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-1470
Practice Address - Fax:413-528-3167
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV149367A00000X
MA367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife