Basic Information
| Provider Information | |||||||||
| NPI: | 1902097769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUJNO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | L | ||||||||
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| NameSuffix: | II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | RAYMOND | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030771220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038953351 | ||||||||
| FaxNumber: | 6038950773 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | RAYMOND | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030771220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038953351 | ||||||||
| FaxNumber: | 6038950773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 04/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 035848-23 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 30005672 | 05 | NH | MEDICAID |