Provider Demographics
NPI:1164498929
Name:ORLANDO, LISA MARIE (CPNP, PMHS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ORLANDO
Suffix:
Gender:F
Credentials:CPNP, PMHS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:REYNOLDSRODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP, PMHS
Mailing Address - Street 1:33 BARTLETT STREET, SUITE 305
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-452-2200
Mailing Address - Fax:978-452-2292
Practice Address - Street 1:33 BARTLETT STREET, SUITE 305
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-452-2200
Practice Address - Fax:978-452-2292
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP455301OtherMEDICARE PTAN
MANP455301OtherMEDICARE PTAN
MANP4553Medicare ID - Type Unspecified