Provider Demographics
NPI:1013060664
Name:BROWNE, LISA M (RPA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BROWNE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:6511 SPRING BROOK AVE
Practice Address - Street 2:SUITE 1001
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3709
Practice Address - Country:US
Practice Address - Phone:845-338-0180
Practice Address - Fax:845-338-0180
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011259363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03134530Medicaid
NYA400114115Medicare PIN