Provider Demographics
NPI:1487269114
Name:WENTZELL, LISA A (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:WENTZELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHENEY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3903
Mailing Address - Country:US
Mailing Address - Phone:603-459-8134
Mailing Address - Fax:
Practice Address - Street 1:10 RESEARCH PL STE 202
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2439
Practice Address - Country:US
Practice Address - Phone:978-275-1390
Practice Address - Fax:978-275-1394
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2293965163WW0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care