Healthcare Provider Details

I. General information

NPI: 1114167103
Provider Name (Legal Business Name): LISA MARIE SULLENDER BS, RN, HN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SIMON ST SUITE 3A
NASHUA NH
03060-3046
US

IV. Provider business mailing address

39 SIMON ST SUITE 3A
NASHUA NH
03060-3046
US

V. Phone/Fax

Practice location:
  • Phone: 603-881-8300
  • Fax:
Mailing address:
  • Phone: 603-881-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041183-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: