Healthcare Provider Details

I. General information

NPI: 1770253312
Provider Name (Legal Business Name): LISA IGNUDO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 STATE ST
BOSTON MA
02109-1827
US

IV. Provider business mailing address

158 N BAYBERRY PKWY
MIDDLETOWN DE
19709-9855
US

V. Phone/Fax

Practice location:
  • Phone: 888-555-3627
  • Fax:
Mailing address:
  • Phone: 302-250-3897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberL1-0037587
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: