Provider Demographics
NPI:1831340165
Name:GUERTIN, LISA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:STICKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 PUMPKIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:NH
Mailing Address - Zip Code:03278-4519
Mailing Address - Country:US
Mailing Address - Phone:603-456-3415
Mailing Address - Fax:
Practice Address - Street 1:184 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2713
Practice Address - Country:US
Practice Address - Phone:603-627-1102
Practice Address - Fax:603-647-5524
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant