Healthcare Provider Details

I. General information

NPI: 1497870612
Provider Name (Legal Business Name): LAURIE TINA ANDERSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE TINA ANDERSON-PLOWMAN CNP

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 DOUGLAS PIKE
SMITHFIELD RI
02917-1291
US

IV. Provider business mailing address

17 ROGLER FARM RD
SMITHFIELD RI
02917-1219
US

V. Phone/Fax

Practice location:
  • Phone: 401-232-6220
  • Fax:
Mailing address:
  • Phone: 401-233-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN000823
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberAPRN00823
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: