=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558017533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ANN ALLISON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2022
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 CAMBRIDGE ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-438-3595
-----------------------------------------------------
Fax | 781-438-3601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 GLAD VALLEY DR
-----------------------------------------------------
City | BILLERICA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01821-2617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-789-6339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AG02220100
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------