Healthcare Provider Details

I. General information

NPI: 1386661221
Provider Name (Legal Business Name): LISA MARIE NOLAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE SCHRANK PA-C

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 AVE E
HONDO TX
78861
US

IV. Provider business mailing address

675 HWY 90 E
HONDO TX
78861
US

V. Phone/Fax

Practice location:
  • Phone: 830-426-7700
  • Fax: 830-426-7860
Mailing address:
  • Phone: 812-212-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberPA04698
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000200A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: