Healthcare Provider Details

I. General information

NPI: 1295537835
Provider Name (Legal Business Name): LISA MARIE HADDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MIDSTATE DR STE 100
AUBURN MA
01501-1856
US

IV. Provider business mailing address

51 BAY VIEW DRIVE
SHREWSBURY MA
01545-0154
US

V. Phone/Fax

Practice location:
  • Phone: 774-321-2030
  • Fax:
Mailing address:
  • Phone: 508-887-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number178801
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: