Provider Demographics
NPI:1386661221
Name:NOLAN, LISA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SCHRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:675 HWY 90 E
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861
Mailing Address - Country:US
Mailing Address - Phone:812-212-3074
Mailing Address - Fax:
Practice Address - Street 1:3100 AVE E
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861
Practice Address - Country:US
Practice Address - Phone:830-426-7700
Practice Address - Fax:830-426-7860
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04698207QH0002X
IN10000200A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine