Individual
LISA A. TABENKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
33 SEWALL ST, PORTLAND, ME 04102-2603
(207) 828-2100
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7800
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP81696
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124018387
—
ME
Enumeration date
10/27/2005
Last updated
10/21/2021
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