Provider Demographics
NPI:1053905166
Name:LISEK, IRENA URSZULA (CNP)
Entity type:Individual
Prefix:MS
First Name:IRENA
Middle Name:URSZULA
Last Name:LISEK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:IRENA
Other - Middle Name:URSZULA
Other - Last Name:LISEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNP
Mailing Address - Street 1:15 OLD WEST ELM ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1731
Mailing Address - Country:US
Mailing Address - Phone:781-202-9292
Mailing Address - Fax:
Practice Address - Street 1:15 OLD WEST ELM ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1731
Practice Address - Country:US
Practice Address - Phone:781-202-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily