Provider Demographics
NPI:1891332060
Name:SZUKSTA, LISA JANET (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JANET
Last Name:SZUKSTA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1240
Mailing Address - Country:US
Mailing Address - Phone:978-726-3851
Mailing Address - Fax:
Practice Address - Street 1:22 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-1240
Practice Address - Country:US
Practice Address - Phone:978-726-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily