=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467608547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MCLAUGHLIN-CONTRERAS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2008
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 MERTON MINTER ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-949-9702
-----------------------------------------------------
Fax | 210-949-3445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5107 MEDICAL DR
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-8612
-----------------------------------------------------
Fax | 210-615-1666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 693935
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------