Provider Demographics
NPI:1225702749
Name:SMELEK, LISA MARIE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SMELEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MOREDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1621 LAKEVILLE DR STE 304
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2694
Mailing Address - Country:US
Mailing Address - Phone:281-305-0411
Mailing Address - Fax:281-572-0627
Practice Address - Street 1:1621 LAKEVILLE DR STE 304
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2694
Practice Address - Country:US
Practice Address - Phone:281-305-0411
Practice Address - Fax:281-572-0627
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX831262163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant