Healthcare Provider Details

I. General information

NPI: 1811018179
Provider Name (Legal Business Name): LISA M. SNELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 FALLING LEAVES DR
ADKINS TX
78101-2624
US

IV. Provider business mailing address

727 FALLING LEAVES DR
ADKINS TX
78101-2624
US

V. Phone/Fax

Practice location:
  • Phone: 830-460-1484
  • Fax: 830-393-8294
Mailing address:
  • Phone: 830-460-1484
  • Fax: 830-393-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80231
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: