Provider Demographics
NPI:1124577564
Name:MONTANO BREA, LISY (NP)
Entity Type:Individual
Prefix:
First Name:LISY
Middle Name:
Last Name:MONTANO BREA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9495 MARSH LN
Mailing Address - Street 2:SUITE100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4946
Mailing Address - Country:US
Mailing Address - Phone:214-351-0010
Mailing Address - Fax:214-351-0375
Practice Address - Street 1:9495 MARSH LN
Practice Address - Street 2:SUITE100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4946
Practice Address - Country:US
Practice Address - Phone:214-351-0010
Practice Address - Fax:214-351-0375
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily