Individual
LISA ANN THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
7 HIGHWOOD ST, WATERVILLE, ME 04901-5739
(207) 873-0705
Mailing address
6 CHETS MEADOW RD, WEST GARDINER, ME 04345-3580
(207) 724-3139
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP181186
ME
Other
Enumeration date
10/17/2018
Last updated
10/17/2018
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