Provider Demographics
NPI:1871572081
Name:PLANTE, LISA (PA-C)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:PLANTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-516-4268
Mailing Address - Fax:603-609-6147
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:SUITE 303
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-516-4268
Practice Address - Fax:603-609-6147
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1353363A00000X
NH0496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3081002Medicaid
NHP01116274OtherRAILROAD MEDICARE
NHP01116274OtherRAILROAD MEDICARE
MAP43396Medicare UPIN
NHAP156706Medicare PIN