Provider Demographics
NPI:1134793391
Name:CIESIELSKI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CIESIELSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2135
Mailing Address - Country:US
Mailing Address - Phone:978-886-0681
Mailing Address - Fax:
Practice Address - Street 1:1 GRIFFIN BROOK DR STE 100
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1865
Practice Address - Country:US
Practice Address - Phone:978-686-0090
Practice Address - Fax:978-681-0459
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN194464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse