Provider Demographics
NPI:1497870612
Name:ANDERSON, LAURIE TINA (CNP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:TINA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:TINA
Other - Last Name:ANDERSON-PLOWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:17 ROGLER FARM RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-1219
Mailing Address - Country:US
Mailing Address - Phone:401-233-0316
Mailing Address - Fax:
Practice Address - Street 1:1150 DOUGLAS PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-1291
Practice Address - Country:US
Practice Address - Phone:401-232-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00823363LS0200X
RIAPRN000823363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool