Individual
SUSAN LIDSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12 UNION ST, ROCKLAND, ME 04841-2739
(207) 701-4400
(207) 701-4486
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 842-6556
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN20742
ME
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP81772
ME
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
CNS84119
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257440099
—
ME
Enumeration date
10/05/2006
Last updated
09/10/2012
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