Individual provider Active NPI

Lisa B Carroll, FNPC

  • Nurse Practitioner
  • Bangor, ME
National Provider Identifier
1194721548
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CNP81527 Issued in ME
Practice address
992 Union St
Bangor, ME 04401-3057
Phone
(207) 945-5247
NPI assigned
Jun 21, 2005
Last updated
May 4, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNP81527 ME Primary

Addresses

Primary practice location

992 Union St
Bangor, ME 04401-3057

Mailing address

PO Box 1599
Bangor, ME 04402-1599
Phone (207) 945-5247

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040317000863 ME Practitioner - Nurse Practitioner 2466342118

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Penobscot Community Health Center CurrentSince Oct 1, 2006 Accepting new patients
Penobscot Community Health Center CurrentSince Oct 1, 2006 Accepting new patients
Penobscot Community Health Center Current Accepting new patients
Independent Medical Associates, PA Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Penobscot Community Health Center Past Accepting new patients
Ross Manor Associates Past Accepting new patients

Locations

1012 Union St
Ste 1
Bangor, ME 04401
Phone 2079455247407

1012 Union St
Ste 3
Bangor, ME 04401
Phone (207) 404-8040

78 Ridgewood Dr
Bangor, ME 04401
Phone (207) 947-0768

992 Union St
Ste 5
Bangor, ME 04401
Phone (207) 992-2601

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1194721548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044021599",
            "telephone_number": "207-945-5247",
            "fax_number": "207-992-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "992 UNION ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013057",
            "telephone_number": "207-945-5247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "LISA",
        "middle_name": "B",
        "credential": "FNPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-21",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ME",
            "license": "CNP81527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

Verify at the official NPI Registry.