Provider Demographics
NPI:1700081866
Name:ROWE, LISA A (APRN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:ROWE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1239
Mailing Address - Country:US
Mailing Address - Phone:201-476-0040
Mailing Address - Fax:201-391-4837
Practice Address - Street 1:70 PARK AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1239
Practice Address - Country:US
Practice Address - Phone:201-476-0040
Practice Address - Fax:201-391-4837
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002707207V00000X
NH091573-23363LW0102X
NJ26NJ00349300363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83222Medicare UPIN