Provider Demographics
NPI:1396701470
Name:MILNE, LISA S (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:MILNE
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:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-0500
Mailing Address - Country:US
Mailing Address - Phone:207-528-8010
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:50 SUMMER ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1400
Practice Address - Country:US
Practice Address - Phone:207-528-8010
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1264-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43920100Medicaid
S65678Medicare UPIN
WI003660080Medicare ID - Type Unspecified