Healthcare Provider Details

I. General information

NPI: 1215366141
Provider Name (Legal Business Name): LISA A MIFFITT LILSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PROSPECT ST
NASHUA NH
03060
US

IV. Provider business mailing address

7 PROSPECT ST
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-6147
  • Fax: 603-883-1568
Mailing address:
  • Phone: 603-889-6147
  • Fax: 603-883-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number05079423
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number050794-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: