Provider Demographics
NPI:1437143526
Name:DOWD, LISA J (RNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:DOWD
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:401-274-4800
Mailing Address - Fax:401-454-0410
Practice Address - Street 1:44 W RIVER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-274-4800
Practice Address - Fax:401-454-0410
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPPRI28707363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILD36987Medicaid
RI405828OtherBLUE CHIP
RI007010124Medicare PIN
RILD36987Medicaid