Provider Demographics
NPI:1407980584
Name:DELAHANTY, LISA RAE (ARNP,MSN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RAE
Last Name:DELAHANTY
Suffix:
Gender:F
Credentials:ARNP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-1906
Mailing Address - Country:US
Mailing Address - Phone:603-627-1314
Mailing Address - Fax:
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-230-7266
Practice Address - Fax:603-230-7298
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH021491-23363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3009532Medicaid
NHNP084201Medicare PIN
NHS46917Medicare UPIN