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NPI Code Detail

MEDICARE: LISA L MCDERMOTT

MEDICARE: LISA L MCDERMOTT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse123663CT

General Provider Information

NPI Number : 1114893773
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA L MCDERMOTT
Provider Business Mailing Address
First Line : 7 GEORGE ST
Second Line :
City : CROMWELL
State : CT
Zip : 06416-1627
Country : US
Telephone Number : 868-609-9595
Fax Number :
Provider Business Practice Location Address
First Line : 177 WESTON ST
Second Line :
City : HARTFORD
State : CT
Zip : 06120-1514
Country : US
Telephone Number : 860-240-1840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2025
Last Update Date : 10/13/2025

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Directions to “ LISA L MCDERMOTT ” Practice Location

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