Provider Demographics
NPI:1326155862
Name:REISER, LORRAINE M (FNP-C2)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:M
Last Name:REISER
Suffix:
Gender:
Credentials:FNP-C2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04853-3320
Mailing Address - Country:US
Mailing Address - Phone:207-867-2021
Mailing Address - Fax:207-867-2258
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:ME
Practice Address - Zip Code:04853-3320
Practice Address - Country:US
Practice Address - Phone:207-867-2021
Practice Address - Fax:207-867-2258
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151136363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016985070002Medicaid
PATP004306WOtherLICENSE