Provider Demographics
NPI:1467780825
Name:CANAS, LISA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CANAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BLOOMFIELD AVENUE
Mailing Address - Street 2:PROHEALTH PHYSICIANS STUDENT HEALTH SERVICES
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117
Mailing Address - Country:US
Mailing Address - Phone:860-768-6601
Mailing Address - Fax:860-768-5140
Practice Address - Street 1:200 BLOOMFIELD AVENUE
Practice Address - Street 2:PROHEALTH PHYSICIANS STUDENT HEALTH SERVICES
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117
Practice Address - Country:US
Practice Address - Phone:860-768-6601
Practice Address - Fax:860-768-5140
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002387363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics