Provider Demographics
NPI:1699019091
Name:SANFILIPPO, LISA A (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:SANFILIPPO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TUFTS LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1377
Mailing Address - Country:US
Mailing Address - Phone:508-284-7372
Mailing Address - Fax:
Practice Address - Street 1:3 TUFTS LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1377
Practice Address - Country:US
Practice Address - Phone:508-284-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2257846163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse