Provider Demographics
NPI:1720669377
Name:KEER, LISA
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:KEER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:CARUSONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NBC-HWC
Mailing Address - Street 1:308 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 CONANT RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1755
Practice Address - Country:US
Practice Address - Phone:978-239-3705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNBC-HWC