Dawn Lisa Lidstone, FNP
Individual provider Active NPI Family Nurse Practitioner · Canaan, CT
NPI 1922403542 · NPPES record last updated Jun 24, 2020
Key facts
- NPI
- 1922403542
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 007744 (CT)
- Practice address
- 76 Church St
Canaan, CT 06018-2447 - Phone
- (860) 624-0731
- NPI assigned
- Oct 24, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NY, CT, MA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150401000459 | NY | Practitioner - Nurse Practitioner | 1456678424 | Reassigns benefits to 1 organization |
| I20181004002792 | CT | Practitioner - Nurse Practitioner | 1456678424 | Reassigns benefits to 2 organizations |
| I20220809003670 | MA | Practitioner - Nurse Practitioner | 1456678424 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007744 | CT | MD | Clinical Social Worker |
| 087663 | CT | MD | General Practice Registered Nurse |
| 284722 | MA | MD | General Practice Registered Nurse |
| 679700-1 | NY | MD | General Practice Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supportive Behavioral Care of Ma LLC | Current |
Accepting new patients | |
| Signify Health Medical Associates, PLLC | Current |
Accepting new patients | |
| Step Up Care PC LLC | Current |
Accepting new patients | |
| Sun River Health Inc. | Current |
Accepting new patients | |
| Sun River Health Inc | Current | Accepting new patients |
Locations
175 Capital Blvd
Fl 4
Rocky Hill, CT 06067
Phone (860) 380-0452
44 School St
Rm 325
Boston, MA 02108
Phone (508) 831-8558
155 Federal St
Ste 700
Boston, MA 02110
Phone (469) 466-7420
27 Randolph Rd
#A
Howell, NJ 07731
Phone (732) 797-9290
27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951
3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006
1037 Main St
Peekskill, NY 10566
Phone (914) 734-8800
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 087663 | CT | |
| General Practice Registered Nurse | 163WG0000X | 284722 | MA | |
| General Practice Registered Nurse | 163WG0000X | 679700-1 | NY | |
| Family Nurse Practitioner | 363LF0000X | 007744 | CT | Yes |
Addresses
Primary practice location
76 Church St
Canaan, CT 06018-2447
Mailing address
PO Box 438
Southfield, MA 01259-0438
Phone (413) 854-1815
Other providers in Canaan, CT
- Kerry Oneil, LMFT PLLC
- Namuna Kharal
- Dennis J Kobylarz
- Joyce M Kost
- Heather Lacasse
- Lorraine Ustico
- Michael J Mangini Jr.
- Piotr Tomasz Markowicz
- Edward Conrado Martinez
- Mary Patricia Matarainen
All providers in Canaan, CT · Family Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.