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NPI Code Detail

MEDICARE: LISA R MASICA CRNA

MEDICARE: LISA R MASICA CRNA
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
1367500000XCertified Registered Nurse Anesthetist702173TX
2367500000XCertified Registered Nurse AnesthetistAP113013TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
300C40UOTHERTXBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
584100QOTHERTXBCBS
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306824917
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA R MASICA CRNA
Provider Business Mailing Address
First Line : 2000 S MAYS ST STE 201
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7580
Country : US
Telephone Number : 512-244-4272
Fax Number : 956-682-4154
Provider Business Practice Location Address
First Line : 2000 S MAYS ST STE 201
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-7580
Country : US
Telephone Number : 512-244-4272
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 01/13/2021

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Directions to “ LISA R MASICA CRNA” Practice Location

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