Healthcare Provider Details

I. General information

NPI: 1336387943
Provider Name (Legal Business Name): LISA L. CHASE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 RIVERSIDE ST
PORTLAND ME
04103-1070
US

IV. Provider business mailing address

899 RIVERSIDE ST
PORTLAND ME
04103-1070
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1200
  • Fax: 207-871-1232
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR029248
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: