Healthcare Provider Details

I. General information

NPI: 1164227971
Provider Name (Legal Business Name): LISA ERIN GARDNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 POST RD
WARWICK RI
02886-3077
US

IV. Provider business mailing address

23 JUNIPER TRL
NARRAGANSETT RI
02882-2502
US

V. Phone/Fax

Practice location:
  • Phone: 401-691-6000
  • Fax: 401-738-7718
Mailing address:
  • Phone: 401-691-6000
  • Fax: 401-738-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN35195
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: