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General NPI Number Information
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NPI Number | 1730419862
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Entity Type | Individual
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Provider Name | LISA MOORMAN RN
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Gender | Female
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 140 WORCESTER ST
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1765
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Country | US
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Telephone | 508-835-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 11 BERRY LN
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City | ACTON
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State | MA
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Zip | 01720-5503
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Country | US
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Telephone |
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 254843
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 10947611
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License Number State | MA
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