Lisak, Maryann

Lisak, Maryann is an sole proprietor health care provider with primary practice located at 128 Lakeside Ave Suite 115, Burlington VT 05401-4939. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Lisak, Maryann can be contacted via phone (802) 860-1928.

Contact Information

Primary practice address
128 Lakeside Ave Suite 115 Burlington VT 05401-4939
Phone: (802) 860-1928
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 101.0019912 Vermont
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 1010019912 Vermont

Profile Details

NPI number 1790732899
LBN Legal business name Lisak, Maryann
Credentials RN, MS, PNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 27th, 2006
Last updated Jul 20th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790732899 NPPES
Vermont MEDICAID 6703781

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