Provider Demographics
NPI:1164005807
Name:HADORN, LISA MICHELE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:HADORN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 TRINITY
Mailing Address - Street 2:BLDG A, SUITE 9.901S
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712
Mailing Address - Country:US
Mailing Address - Phone:512-324-7831
Mailing Address - Fax:512-324-7875
Practice Address - Street 1:1601 TRINITY
Practice Address - Street 2:BLDG A, SUITE 9.901S
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712
Practice Address - Country:US
Practice Address - Phone:512-324-7831
Practice Address - Fax:512-324-7875
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily