Provider Demographics
NPI:1831230341
Name:MORIN, LISA B (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:MORIN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:177 NORTH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2998
Mailing Address - Country:US
Mailing Address - Phone:508-660-6826
Mailing Address - Fax:
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-769-4660
Practice Address - Fax:781-769-0371
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1193363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1831230341OtherNPI