Healthcare Provider Details

I. General information

NPI: 1124316187
Provider Name (Legal Business Name): LISA E. GEARY RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE THE MIRIAM HOSPITAL
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-4005
  • Fax:
Mailing address:
  • Phone: 401-793-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN33601
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37590
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: