=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164227971
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ERIN GARDNER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2025
-----------------------------------------------------
Last Update Date | 02/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2756 POST RD
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02886-3077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-691-6000
-----------------------------------------------------
Fax | 401-738-7718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 JUNIPER TRL
-----------------------------------------------------
City | NARRAGANSETT
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02882-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-691-6000
-----------------------------------------------------
Fax | 401-738-7718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN35195
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------