Provider Demographics
NPI:1215952239
Name:MAHEU, LISA A (PA-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:MAHEU
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2 MEDICAL CENTER DR STE 410
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1273
Mailing Address - Country:US
Mailing Address - Phone:413-748-7095
Mailing Address - Fax:413-732-0225
Practice Address - Street 1:300 STAFFORD ST STE 154
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3583
Practice Address - Country:US
Practice Address - Phone:413-748-7095
Practice Address - Fax:413-733-5604
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAAP2149363A00000X
MAPA2149363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant