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General NPI Number Information
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NPI Number | 1740992106
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Entity Type | Individual
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Provider Name | VISI MARCO LAWONG NP
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Gender | Male
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 12/16/2022
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Provider Practice Location Address
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Address Line | 16850 BUCCANEER LN
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City | HOUSTON
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State | TX
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Zip | 77058-2507
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Country | US
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Telephone | 833-971-2356
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Fax |
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Provider Business Mailing Address
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Address Line | 430 AMBERWOOD PARK DR
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City | KATY
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State | TX
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Zip | 77493-4746
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Country | US
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Telephone | 216-801-7195
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1088705
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License Number State | TX
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