Provider Demographics
NPI:1669473849
Name:LISK, LINDA J (CNM)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:J
Last Name:LISK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:337 NOTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1826
Mailing Address - Country:US
Mailing Address - Phone:203-483-1119
Mailing Address - Fax:203-643-0096
Practice Address - Street 1:337 NOTCH HILL RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1826
Practice Address - Country:US
Practice Address - Phone:203-483-1119
Practice Address - Fax:203-643-0096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000039367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife