Provider Demographics
NPI:1043781701
Name:SALAZAR, LISA VERCELLINO (MSN, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:VERCELLINO
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:MSN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 HEATHERSAGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3277
Mailing Address - Country:US
Mailing Address - Phone:281-731-5761
Mailing Address - Fax:
Practice Address - Street 1:THE WOMAN'S HOSPITAL OF TEXAS
Practice Address - Street 2:7600 FANNIN
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-791-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141320363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal