Provider Demographics
NPI:1083102081
Name:LESSARD, MARYANN WILLARD (RN-LACTATION SPECIAL)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:WILLARD
Last Name:LESSARD
Suffix:
Gender:F
Credentials:RN-LACTATION SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 OLD LAKE SHORE RD G-9
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249
Mailing Address - Country:US
Mailing Address - Phone:603-496-2073
Mailing Address - Fax:
Practice Address - Street 1:303 OLD LAKE SHORE RD G-9
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249
Practice Address - Country:US
Practice Address - Phone:603-496-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH022142-21163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant