Individual
LEISA SIERRA LORD-HALVORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
450 BROOKLINE AVE, BOSTON, MA 02215-5450
(617) 632-3000
(617) 582-6021
Mailing address
450 BROOKLINE AVE, BOSTON, MA 02215-5450
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA7730
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110164413A
—
MA
Enumeration date
11/04/2018
Last updated
05/01/2025
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