Provider Demographics
NPI:1083082531
Name:HIEBER, LYSA (NP-C)
Entity Type:Individual
Prefix:
First Name:LYSA
Middle Name:
Last Name:HIEBER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N LOOP 1604 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1450
Mailing Address - Country:US
Mailing Address - Phone:866-456-7968
Mailing Address - Fax:866-554-5042
Practice Address - Street 1:227 N LOOP 1604 E STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1450
Practice Address - Country:US
Practice Address - Phone:866-456-7968
Practice Address - Fax:866-554-5042
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily