Provider Demographics
NPI:1104974286
Name:O'CONNOR, LISA MILLER (NP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MILLER
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24 HERITAGE HILL
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-326-2134
Mailing Address - Fax:
Practice Address - Street 1:100 CHARLES RIVER PLAZA
Practice Address - Street 2:SUITE 403
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3373
Practice Address - Fax:617-724-9811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213317363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health