Provider Demographics
NPI:1255849840
Name:MAJOR, LISA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MAJOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:EBERWEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6 COMMONS ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4651
Mailing Address - Country:US
Mailing Address - Phone:802-775-1903
Mailing Address - Fax:802-775-5503
Practice Address - Street 1:6 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4651
Practice Address - Country:US
Practice Address - Phone:802-775-1903
Practice Address - Fax:802-775-5503
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031377363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical