Healthcare Provider Details

I. General information

NPI: 1326115460
Provider Name (Legal Business Name): LISA MICHELE BOLDUC-BISSELL RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE CSC
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

242 ROBBINS MOUNTAIN RD
RICHMOND VT
05477-9285
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-6200
  • Fax: 802-847-5364
Mailing address:
  • Phone: 802-434-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number026-0022848
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: