Provider Demographics
NPI:1922300870
Name:DECESARE, LISA M (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DECESARE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-2494
Mailing Address - Fax:207-795-2732
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-2494
Practice Address - Fax:207-795-2732
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2016-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MECNP101058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002042602Medicare PIN
ME002042601Medicare PIN