Provider Demographics
NPI:1699847004
Name:ATWOOD, LISA SUSSDORFF (APRN, NNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUSSDORFF
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:APRN, NNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARY
Other - Last Name:SUSSDORFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:PORT KENT
Mailing Address - State:NY
Mailing Address - Zip Code:12975-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0025747363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care