Provider Demographics
NPI:1649757642
Name:FLEECE, LISA LOUISE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LOUISE
Last Name:FLEECE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GALAHAD LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2220
Mailing Address - Country:US
Mailing Address - Phone:631-672-7498
Mailing Address - Fax:
Practice Address - Street 1:5 CUBA HILL RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1624
Practice Address - Country:US
Practice Address - Phone:631-628-5000
Practice Address - Fax:631-628-5722
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife