Provider Demographics
NPI:1366487258
Name:STARKWEATHER, LISA A (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STARKWEATHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1311
Mailing Address - Country:US
Mailing Address - Phone:207-924-7349
Mailing Address - Fax:207-924-5343
Practice Address - Street 1:51 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1311
Practice Address - Country:US
Practice Address - Phone:207-924-7349
Practice Address - Fax:207-924-5343
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER036742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00424129OtherRAILROAD MEDICARE
MENP423202OtherPTAN
MENP423202OtherPTAN
MENP423202OtherPTAN
MEMS1019985OtherDEA