Provider Demographics
NPI:1710206693
Name:MAIDA, LISA M (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:M
Last Name:MAIDA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ACORN CIR APT 19
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1205
Mailing Address - Country:US
Mailing Address - Phone:631-372-7450
Mailing Address - Fax:
Practice Address - Street 1:84 ACORN CIR APT 19
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1205
Practice Address - Country:US
Practice Address - Phone:631-372-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293448-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse