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NPI Code Detail

MEDICARE: LISA LANDOW APRN

MEDICARE:   LISA  LANDOW  APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner003021CT

General Provider Information

NPI Number : 1235136383
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA LANDOW APRN
Provider Business Mailing Address
First Line : 81 SPRING ST
Second Line :
City : CHESTER
State : CT
Zip : 06412-1357
Country : US
Telephone Number : 860-767-1505
Fax Number :
Provider Business Practice Location Address
First Line : 81 SPRING ST
Second Line :
City : CHESTER
State : CT
Zip : 06412-1357
Country : US
Telephone Number : 860-767-1505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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Directions to “ LISA LANDOW APRN” Practice Location

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