Provider Demographics
NPI:1467938241
Name:CUSHING, LISA S (PA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:CUSHING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 WHITE MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-4204
Mailing Address - Country:US
Mailing Address - Phone:603-447-8900
Mailing Address - Fax:603-447-4846
Practice Address - Street 1:298 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-4204
Practice Address - Country:US
Practice Address - Phone:603-447-8900
Practice Address - Fax:603-447-4846
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant