MEDICARE: LISA RENE MCDONALD DNP, APRN, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	583557	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP112503	TX
3	207K00000X	Allergy & Immunology Physician	AP112503	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	806N39	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447331277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA RENE MCDONALD DNP, APRN, CPNP

Provider Business Mailing Address
First Line	:	2127 IH 10W
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-3154
Country	:	US
Telephone Number	:	210-899-6856
Fax Number	:	210-750-3056

Provider Business Practice Location Address
First Line	:	2127 IH 10W
Second Line	:	SUITE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-3154
Country	:	US
Telephone Number	:	210-899-6856
Fax Number	:	210-750-3056

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/27/2023

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