Healthcare Provider Details

I. General information

NPI: 1932505849
Provider Name (Legal Business Name): LISA BOWLAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

IV. Provider business mailing address

140 DAMERON AVE
KNOXVILLE TN
37917-6413
US

V. Phone/Fax

Practice location:
  • Phone: 865-215-5000
  • Fax: 865-215-5199
Mailing address:
  • Phone: 865-215-5000
  • Fax: 865-215-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000058456
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: