Provider Demographics
NPI:1578644266
Name:FOWLER, LANA K (ARNP, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:K
Last Name:FOWLER
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 GEORGE WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4257
Mailing Address - Country:US
Mailing Address - Phone:888-771-1874
Mailing Address - Fax:401-770-1998
Practice Address - Street 1:695 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4257
Practice Address - Country:US
Practice Address - Phone:888-771-1874
Practice Address - Fax:401-770-1998
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146862363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOX93000018Medicare UPIN