Healthcare Provider Details

I. General information

NPI: 1144897810
Provider Name (Legal Business Name): ANDREA LAWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WAMPANOAG TRL STE 302B
RIVERSIDE RI
02915-2235
US

IV. Provider business mailing address

375 WAMPANOAG TRL STE 302B
RIVERSIDE RI
02915-2235
US

V. Phone/Fax

Practice location:
  • Phone: 401-649-4070
  • Fax:
Mailing address:
  • Phone: 401-649-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: