MEDICARE: AMENZE LISA AGHIMIEN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP132201	TX

General Provider Information

NPI Number	:	1093256141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMENZE LISA AGHIMIEN FNP-C

Provider Business Mailing Address
First Line	:	12377 MERIT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-2224
Country	:	US
Telephone Number	:	972-957-3000
Fax Number	:	972-957-3005

Provider Business Practice Location Address
First Line	:	10058A LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-4002
Country	:	US
Telephone Number	:	832-380-3980
Fax Number	:	832-380-3985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/01/2022

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