Provider Demographics
NPI:1922239763
Name:ANDERSON, LISA C (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JOANNE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1299
Mailing Address - Country:US
Mailing Address - Phone:508-748-0226
Mailing Address - Fax:
Practice Address - Street 1:30 JOANNE DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1299
Practice Address - Country:US
Practice Address - Phone:508-748-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program