Provider Demographics
NPI:1275867301
Name:KIRSCHNER, LISA MORIARTY (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MORIARTY
Last Name:KIRSCHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2712
Mailing Address - Country:US
Mailing Address - Phone:860-696-2350
Mailing Address - Fax:860-696-2360
Practice Address - Street 1:1559 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2712
Practice Address - Country:US
Practice Address - Phone:860-696-2450
Practice Address - Fax:860-696-2360
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262902363L00000X
CT4206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1275867301OtherNPI
CT4206OtherCT APRN LICENSE
MARN2262902OtherMA LICENSE