Provider Demographics
NPI:1639965676
Name:DEROSIER, LISA ANN (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DEROSIER
Suffix:
Gender:
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:NH
Mailing Address - Zip Code:03588-0054
Mailing Address - Country:US
Mailing Address - Phone:603-723-8241
Mailing Address - Fax:
Practice Address - Street 1:59 PAGE HILL RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NH
Practice Address - Zip Code:03570-3542
Practice Address - Country:US
Practice Address - Phone:603-326-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048079-21163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse