Provider Demographics
NPI:1659394435
Name:LUZ, LISA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LUZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 CONCORD AVE
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1040
Mailing Address - Country:US
Mailing Address - Phone:617-499-6767
Mailing Address - Fax:617-499-6768
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 5100
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-499-6767
Practice Address - Fax:617-499-6768
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110082785AMedicaid
MA110082785AMedicaid