Provider Demographics
NPI:1588910129
Name:ROSEBERRY, LISA KATHRYN (APRN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KATHRYN
Last Name:ROSEBERRY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2222
Mailing Address - Country:US
Mailing Address - Phone:603-601-3989
Mailing Address - Fax:603-601-3989
Practice Address - Street 1:408 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2222
Practice Address - Country:US
Practice Address - Phone:603-601-3989
Practice Address - Fax:603-601-3989
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2025-03-18
Deactivation Date:2020-10-14
Deactivation Code:
Reactivation Date:2020-10-21
Provider Licenses
StateLicense IDTaxonomies
MARN204517363L00000X
NH051227-23363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106269Medicaid
NHT400345642Medicare PIN
NH3106269Medicaid