Provider Demographics
NPI:1144203266
Name:SIMONIAN, LISA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:SIMONIAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:46 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7409
Mailing Address - Country:US
Mailing Address - Phone:978-685-9121
Mailing Address - Fax:617-234-7981
Practice Address - Street 1:1575 CAMBRIDGE ST
Practice Address - Street 2:YOUVILLE HOSPITAL
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4398
Practice Address - Country:US
Practice Address - Phone:617-876-4344
Practice Address - Fax:617-234-7981
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA194643363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0322504Medicare ID - Type Unspecified
MANP0578Medicare ID - Type Unspecified
S10592Medicare UPIN