Healthcare Provider Details

I. General information

NPI: 1144203266
Provider Name (Legal Business Name): LISA M SIMONIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 CAMBRIDGE ST YOUVILLE HOSPITAL
CAMBRIDGE MA
02138-4398
US

IV. Provider business mailing address

46 ANDERSON DR
METHUEN MA
01844-7409
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-4344
  • Fax: 617-234-7981
Mailing address:
  • Phone: 978-685-9121
  • Fax: 617-234-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN194643
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number194643
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: