Provider Demographics
NPI:1538244645
Name:FOWNES, LISA (RNCS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FOWNES
Suffix:
Gender:F
Credentials:RNCS
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Mailing Address - Street 1:105 BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1805
Mailing Address - Country:US
Mailing Address - Phone:617-932-1814
Mailing Address - Fax:617-932-1843
Practice Address - Street 1:26 TRAPELO RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-932-1814
Practice Address - Fax:617-932-1843
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA152682163W00000X
MARN152682364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN5071OtherBCBS