Provider Demographics
NPI:1215711213
Name:QUARAGLIA, LISA THERESE (NP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:THERESE
Last Name:QUARAGLIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4136
Mailing Address - Country:US
Mailing Address - Phone:781-864-5268
Mailing Address - Fax:
Practice Address - Street 1:100 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4136
Practice Address - Country:US
Practice Address - Phone:781-864-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG06230264363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology