Individual
MS. MARYANN LISAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MS, PNP
Contact information
Practice address
128 LAKESIDE AVE, SUITE 115, BURLINGTON, VT 05401-4939
(802) 860-1928
Mailing address
128 LAKESIDE AVE, SUITE 115, BURLINGTON, VT 05401-4939
(802) 860-1928
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
1010019912
VT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
101.0019912
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6703781
—
VT
Enumeration date
05/27/2006
Last updated
07/20/2021
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