NPI Code Detail JSON Logo

1639685589 NPI number — LISA CLEMENTE MSN, AGPCNP-C

NPI Number: 1639685589
Health Care Provider/Practitioner: LISA CLEMENTE MSN, AGPCNP-C

Information about “1639685589” NPI (LISA CLEMENTE MSN, AGPCNP-C) exists in 1639685589 in HTML format HTML  |  1639685589 in plain Text format TXT  |  1639685589 in PDF (Portable Document Format) PDF  |  1639685589 in an XML format XML  formats.

NPI Number : 1639685589 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639685589",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLEMENTE",
    "FirstName": "LISA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSN, AGPCNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "114 WATER ST",
    "SecondLineMailingAddress": "STE 4",
    "MailingAddressCityName": "MILFORD",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "01757-3007",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "508-473-8373",
    "MailingAddressFaxNumber": "508-634-8444",
    "FirstLinePracticeLocationAddress": "54 HOPEDALE ST STE 9",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOPEDALE",
    "PracticeLocationAddressStateName": "MA",
    "PracticeLocationAddressPostalCode": "01747-1732",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "508-473-8373",
    "PracticeLocationAddressFaxNumber": "508-634-8744",
    "EnumerationDate": "12/14/2017",
    "LastUpdateDate": "08/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "RN201245",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "12170041",
          "LicenseNumberStateCode": "MA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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