Healthcare Provider Details

I. General information

NPI: 1588926133
Provider Name (Legal Business Name): LISA G HUSER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S WOODLAND BLVD SUITE 202
DELAND FL
32720-5445
US

IV. Provider business mailing address

120 S WOODLAND BLVD SUITE 204
DELAND FL
32720-5445
US

V. Phone/Fax

Practice location:
  • Phone: 386-490-4412
  • Fax:
Mailing address:
  • Phone: 386-490-4412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1755582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN1755582
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN1755582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: