Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP132050 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP132050 | TX |
NPI | 1245781830 |
---|---|
Provider Name | Lisa Marie Elizalde |
First Address | Harlingen, TX 78550-2522 |
Second Address | Harlingen, TX 78550-2522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 01/09/2020 |