Provider Demographics
NPI:1316989379
Name:AUBIN, LISA MARIE (CNM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:AUBIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:CAPPAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL ROAD
Practice Address - Street 2:SUITE 1B
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200813367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079544AMedicaid
MA110079544AMedicaid