Individual
LISA NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1300 CRYSTAL RD, ISLAND FALLS, ME 04747-4369
(207) 463-3600
(207) 463-3603
Mailing address
PO BOX 500, PATTEN, ME 04765-0500
(207) 528-2285
(207) 528-2880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
013731
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048673
ANTHEM STAR #
ME
01
—
119411700
FEDERAL W/C GROUP
ME
01
—
144828
AETNA GROUP
ME
01
—
203814
NHIC GROUP PTAN
ME
05
—
298050099
—
ME
01
—
5236796
CIGNA
ME
01
—
F77297
HARVARD PILGRAM
ME
01
—
P00301812
RR MEDICARE
ME
Enumeration date
06/09/2006
Last updated
04/04/2016
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