Provider Demographics
NPI:1881780427
Name:LOVE, LISA DIANE (APRN - CNS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:LOVE
Suffix:
Gender:F
Credentials:APRN - CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146B HARPSWELL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7813
Mailing Address - Country:US
Mailing Address - Phone:207-522-7312
Mailing Address - Fax:
Practice Address - Street 1:146 B HARPSWELL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-522-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER028808364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P17419Medicare UPIN
MENS803501Medicare PIN
MENS8035Medicare ID - Type Unspecified