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General NPI Number Information
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NPI Number | 1659859015
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Entity Type | Individual
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Provider Name | LISA RENEE SWANBERG FNP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2018
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 5 CAMPUS DR
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City | FREEPORT
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State | ME
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Zip | 04033-0003
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Country | US
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Telephone | 207-523-8550
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SOUTHBOROUGH DR STE 120
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6978
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Country | US
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Telephone | 207-347-2947
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Fax | 207-874-1483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP181126
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License Number State | ME
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