Healthcare Provider Details

I. General information

NPI: 1801808605
Provider Name (Legal Business Name): LISA ELLEN HEGEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
LEBANON NH
03756-1000
US

IV. Provider business mailing address

PO BOX 246
MERIDEN NH
03770-0246
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-3880
  • Fax:
Mailing address:
  • Phone: 603-469-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number032395-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: