Healthcare Provider Details

I. General information

NPI: 1528518982
Provider Name (Legal Business Name): LILIANE LOWE FAXIGUE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 GATTIS SCHOOL RD
ROUND ROCK TX
78664-7428
US

IV. Provider business mailing address

1855 GATTIS SCHOOL RD
ROUND ROCK TX
78664-7428
US

V. Phone/Fax

Practice location:
  • Phone: 512-501-9606
  • Fax:
Mailing address:
  • Phone: 512-501-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: