Healthcare Provider Details

I. General information

NPI: 1033935689
Provider Name (Legal Business Name): LIZA MARTINEZ LENSICO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13737 HIGHWAY 36
NEEDVILLE TX
77461-7516
US

IV. Provider business mailing address

13737 HIGHWAY 36
NEEDVILLE TX
77461-7516
US

V. Phone/Fax

Practice location:
  • Phone: 979-793-3940
  • Fax:
Mailing address:
  • Phone: 979-793-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1177701
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: