Provider Demographics
NPI:1902097769
Name:BUJNO, LISA L II
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:BUJNO
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1220
Mailing Address - Country:US
Mailing Address - Phone:603-895-3351
Mailing Address - Fax:603-895-0773
Practice Address - Street 1:128 ROUTE 27
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-1220
Practice Address - Country:US
Practice Address - Phone:603-895-3351
Practice Address - Fax:603-895-0773
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035848-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005672Medicaid
NH30005672Medicaid