Healthcare Provider Details

I. General information

NPI: 1821055773
Provider Name (Legal Business Name): LISA J PUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 BROADWAY STE 101-I
SAUGUS MA
01906-4521
US

IV. Provider business mailing address

999 BROADWAY STE 101-I
SAUGUS MA
01906-4521
US

V. Phone/Fax

Practice location:
  • Phone: 781-832-0035
  • Fax:
Mailing address:
  • Phone: 781-832-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number197514
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number197514
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number197514
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number197514
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: