Provider Demographics
NPI:1104649714
Name:LISA KAZAKIS APRN
Entity type:Organization
Organization Name:LISA KAZAKIS APRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS, PMHNP-BC, FAM -BC/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-325-3106
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-0106
Mailing Address - Country:US
Mailing Address - Phone:603-325-3106
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:603-325-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty