Healthcare Provider Details

I. General information

NPI: 1629134648
Provider Name (Legal Business Name): LISA M MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA M. BURKE NP

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRANKLIN REGIONAL HOSPITAL INPATIENT PSYCH UNIT 15 AIKEN AVE
FRANKLIN NH
03235-0323
US

IV. Provider business mailing address

144 RUMFORD ST APT 1
CONCORD NH
03301-4516
US

V. Phone/Fax

Practice location:
  • Phone: 603-934-2060
  • Fax:
Mailing address:
  • Phone: 603-966-0385
  • Fax: 781-744-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number162110
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number069574-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: