Provider Demographics
NPI:1730589615
Name:WELDON, LISA (PMH-NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WELDON
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6764
Mailing Address - Country:US
Mailing Address - Phone:603-836-5584
Mailing Address - Fax:603-935-7615
Practice Address - Street 1:305 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6764
Practice Address - Country:US
Practice Address - Phone:603-836-5584
Practice Address - Fax:603-935-7615
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2022-10-29
Deactivation Date:2018-10-12
Deactivation Code:
Reactivation Date:2018-10-22
Provider Licenses
StateLicense IDTaxonomies
NH064788-23363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health