Provider Demographics
NPI:1114110012
Name:SAULSBERRY, LISA R (1ST ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:SAULSBERRY
Suffix:
Gender:F
Credentials:1ST ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HOSPITAL DR STE 280
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4663
Mailing Address - Country:US
Mailing Address - Phone:409-835-9500
Mailing Address - Fax:
Practice Address - Street 1:740 HOSPITAL DR STE 280
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4663
Practice Address - Country:US
Practice Address - Phone:409-835-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06-116246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist