Provider Demographics
NPI:1831123793
Name:KILLIPS, LISA M (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:20 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4137
Mailing Address - Country:US
Mailing Address - Phone:413-237-0332
Mailing Address - Fax:413-216-2939
Practice Address - Street 1:20 CASTLE HILL RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4137
Practice Address - Country:US
Practice Address - Phone:413-237-0332
Practice Address - Fax:413-216-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2355363LF0000X
MA187547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA187547OtherMA BORM LICENSE NUMBER
595964Medicare UPIN
MA187547OtherMA BORM LICENSE NUMBER