Provider Demographics
NPI:1013129246
Name:FOSS, LISA B (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:FOSS
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 1:566 BOG RD
Mailing Address - Street 2:
Mailing Address - City:HERMON
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0712
Mailing Address - Country:US
Mailing Address - Phone:207-990-9000
Mailing Address - Fax:207-941-8645
Practice Address - Street 1:1 CUMBERLAND PL STE 108
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5087
Practice Address - Country:US
Practice Address - Phone:207-990-9000
Practice Address - Fax:207-941-8645
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO39858163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health