Provider Demographics
NPI:1083348809
Name:HEBENSTREIT, LISA (FNP-C, RN, ATC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HEBENSTREIT
Suffix:
Gender:F
Credentials:FNP-C, RN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2696
Mailing Address - Country:US
Mailing Address - Phone:617-724-3874
Mailing Address - Fax:617-643-4085
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-3874
Practice Address - Fax:617-643-4085
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2363308163W00000X, 363LF0000X, 363L00000X
MA31042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily