Provider Demographics
NPI:1346416195
Name:MATHAI, LISA (NP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MATHAI
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 1:555 W.INTERSTATE 30
Mailing Address - Street 2:WALMART CARE CLINIC
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5702
Mailing Address - Country:US
Mailing Address - Phone:214-684-9954
Mailing Address - Fax:
Practice Address - Street 1:555 W INTERSTATE 30
Practice Address - Street 2:WALMART CARE CLINIC
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5702
Practice Address - Country:US
Practice Address - Phone:214-684-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily