Provider Demographics
NPI:1205012390
Name:MUNN, LISA MARIE (ANP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:MUNN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:214-645-5337
Mailing Address - Fax:214-645-5339
Practice Address - Street 1:5939 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6246
Practice Address - Country:US
Practice Address - Phone:214-645-5337
Practice Address - Fax:214-645-5339
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX779623163W00000X
TXAP118594363LA2200X
TNAPN0000008306363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621792869OtherTAX IDENTIFICATION #
TN621792869OtherTAX IDENTIFICATION #