=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275778433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MARIE VAN GUILDER NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2008
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 STATE HIGHWAY 35 S
-----------------------------------------------------
City | PORT LAVACA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77979-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-553-6400
-----------------------------------------------------
Fax | 361-553-6456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 STATE HIGHWAY 35 S
-----------------------------------------------------
City | PORT LAVACA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77979-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-553-6400
-----------------------------------------------------
Fax | 361-553-6456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | CNP-01636
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 28145291A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71002855A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP01636
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP-01636
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1181296
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------