Maryann Lisak, RN, MS, PNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Burlington, VT
NPI 1790732899 · NPPES record last updated Jul 20, 2021
Key facts
- NPI
- 1790732899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 101.0019912 (VT)
- Practice address
- 128 Lakeside Ave
Suite 115
Burlington, VT 05401-4939 - Phone
- (802) 860-1928
- NPI assigned
- May 27, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1010019912 | VT | MD | Pediatric Nurse Practitioner |
| 101.0019912 | VT | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 101.0019912 | VT | Yes |
| Pediatric Nurse Practitioner | 363LP0200X | 1010019912 | VT |
Addresses
Primary practice location
128 Lakeside Ave
Suite 115
Burlington, VT 05401-4939
Mailing address
128 Lakeside Ave
Suite 115
Burlington, VT 05401-4939
Phone (802) 860-1928
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6703781 | Medicaid | VT |
Other providers in Burlington, VT
- Joseph Leo Linn
- Kate Linnea
- Grant James Linnell
- Molly Linnell
- Erin Michelle Lips
- Christina Marie Litsakos
- Benjamin Littenberg
- Lydia Littwin
- Sarah Yiqiu Liu
- Aurelija Liubauske
All providers in Burlington, VT · Psychiatric/Mental Health Nurse Practitioner in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2021. 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.