Provider Demographics
NPI:1629134648
Name:MARTIN, LISA M (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:144 RUMFORD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4516
Mailing Address - Country:US
Mailing Address - Phone:603-966-0385
Mailing Address - Fax:781-744-5351
Practice Address - Street 1:FRANKLIN REGIONAL HOSPITAL INPATIENT PSYCH UNIT
Practice Address - Street 2:15 AIKEN AVE
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-0323
Practice Address - Country:US
Practice Address - Phone:603-934-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162110363L00000X
NH069574-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400115988Medicare PIN