Lisa Thibault
Individual provider Active NPI Registered Nurse · Wilton, ME
NPI 1134595218 · NPPES record last updated Aug 12, 2015
Key facts
- NPI
- 1134595218
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 048754 (ME)
- Practice address
- 14 Cross St
Wilton, ME 04294-4050 - Phone
- (207) 578-8351
- NPI assigned
- Aug 12, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 553833 | MA | MD | Registered Nurse |
| 048754 | ME | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 048754 | ME | Yes |
| Registered Nurse | 163W00000X | 553833 | MA |
Addresses
Primary practice location
14 Cross St
Wilton, ME 04294-4050
Mailing address
14 Cross St
Wilton, ME 04294-4050
Phone (207) 578-8351
Other providers in Wilton, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.