Provider Demographics
NPI:1063983690
Name:KAZAKIS, LISA ANN (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KAZAKIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PONDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-5021
Mailing Address - Country:US
Mailing Address - Phone:603-801-0832
Mailing Address - Fax:
Practice Address - Street 1:75 PONDVIEW RD
Practice Address - Street 2:
Practice Address - City:WEARE
Practice Address - State:NH
Practice Address - Zip Code:03281-5021
Practice Address - Country:US
Practice Address - Phone:603-801-0832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2313871363LF0000X, 363LP0808X
NH042820-23363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health