Provider Demographics
NPI:1528711850
Name:RONNING, LISA (PA-C)
Entity type:Individual
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First Name:LISA
Middle Name:
Last Name:RONNING
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:176-779-6700
Practice Address - Fax:617-779-6770
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2025-03-11
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant