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Individual

LISA C PRENTISS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
22 BRAMHALL ST, PAVILION 1203, PORTLAND, ME 04102-7133
(207) 662-4618
(207) 662-6254
Mailing address
301C US ROUTE ONE, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA430
ME

Other

Enumeration date
05/02/2006
Last updated
06/03/2011
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