Provider Demographics
NPI:1538806997
Name:ROTHERMICH, LISA ANN (LICAC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:ROTHERMICH
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PORTSMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-2220
Mailing Address - Country:US
Mailing Address - Phone:603-436-6883
Mailing Address - Fax:
Practice Address - Street 1:330 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2220
Practice Address - Country:US
Practice Address - Phone:603-436-6883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHACP002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty