Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 20111697 | TX |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20111697 | TX |
NPI | 1073882205 |
---|---|
Provider Name | Lisa Pomeroy |
First Address | Austin, TX 78722-2211 |
Second Address | Austin, TX 78722-2211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2011 |
Last Update Date | 26/02/2014 |