Healthcare Provider Details

I. General information

NPI: 1386550150
Provider Name (Legal Business Name): LISA NG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST
BRIDGEPORT CT
06610-2870
US

IV. Provider business mailing address

15 WILTAN DR
MONROE CT
06468-1011
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3000
  • Fax:
Mailing address:
  • Phone: 203-601-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number215772
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: