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General NPI Number Information
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NPI Number | 1780710319
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE HEALTH CLINIC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 601 E WHITESTONE BLVD SUITE 308
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City | CEDAR PARK
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State | TX
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Zip | 78613-9015
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Country | US
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Telephone | 512-528-9996
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Fax | 512-528-9070
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Provider Business Mailing Address
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Address Line | 601 E WHITESTONE BLVD SUITE 308
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City | CEDAR PARK
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State | TX
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Zip | 78613-9015
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Country | US
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Telephone | 512-528-9996
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Fax | 512-528-9070
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | MS. LINDA S. DONOVAN
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Credential | CPNP
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Telephone | 512-528-9996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 629991
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License Number State | TX
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