Provider Demographics
NPI:1134455660
Name:LANTEIGNE, LISA (LIC AC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LANTEIGNE
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LANTEIGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LIC AC
Mailing Address - Street 1:51A GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03076-5200
Mailing Address - Country:US
Mailing Address - Phone:978-505-1398
Mailing Address - Fax:
Practice Address - Street 1:51A GRANITE DR
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NH
Practice Address - Zip Code:03076-5200
Practice Address - Country:US
Practice Address - Phone:978-505-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist