Provider Demographics
NPI:1891810644
Name:KAPLAN DISTASIO, LISA SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:SUE
Last Name:KAPLAN DISTASIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 POST GATE ROAD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1840
Mailing Address - Country:US
Mailing Address - Phone:978-762-0669
Mailing Address - Fax:
Practice Address - Street 1:9 POST GATE ROAD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1840
Practice Address - Country:US
Practice Address - Phone:978-762-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215515163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0703656Medicare UPIN