1669589982 NPI number — LISA PAGE STRYKER CRNA

Table of content: LISA PAGE STRYKER CRNA (NPI 1669589982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669589982 NPI number — LISA PAGE STRYKER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRYKER
Provider First Name:
LISA
Provider Middle Name:
PAGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRUN
Provider Other First Name:
LISA
Provider Other Middle Name:
PAGE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669589982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 ROMANS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03087-1768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-930-0643
Provider Business Mailing Address Fax Number:
603-882-2477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-3925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-889-2624
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  025897-23-11 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30344185 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".