Provider Demographics
NPI:1497746853
Name:FIASCONE, LISA B (PNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:B
Last Name:FIASCONE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NEW DRIFTWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4530
Mailing Address - Country:US
Mailing Address - Phone:781-544-1388
Mailing Address - Fax:781-544-3396
Practice Address - Street 1:10 NEW DRIFTWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4530
Practice Address - Country:US
Practice Address - Phone:781-544-1388
Practice Address - Fax:781-544-3396
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137051363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0340731Medicaid
MANP2425OtherBCBS
P06313Medicare UPIN
MANP2425Medicare ID - Type Unspecified