MEDICARE: LISA ANN BLUM

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
1	363LF0000X	Family Nurse Practitioner	1084712	TX
2	363L00000X	Nurse Practitioner	1084712	TX

General Provider Information

NPI Number	:	1053047209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN BLUM

Provider Business Mailing Address
First Line	:	6913 N 40TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5400
Country	:	US
Telephone Number	:	956-534-1471
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 N 40TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-5400
Country	:	US
Telephone Number	:	956-534-1471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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Directions to “ LISA ANN BLUM ” Practice Location

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