Provider Demographics
NPI:1033604111
Name:YISA, DEBORAH OLUSOLA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:OLUSOLA
Last Name:YISA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 SANDERS HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6395
Mailing Address - Country:US
Mailing Address - Phone:832-757-3060
Mailing Address - Fax:
Practice Address - Street 1:12703 ALIEF CLODINE RD
Practice Address - Street 2:STE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5487
Practice Address - Country:US
Practice Address - Phone:832-757-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137145363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP137145Medicaid
TXAP137145OtherFAMILY NURSE PRACTITIONER