Provider Demographics
NPI:1417656158
Name:JOHN, LIJI (FNP-C)
Entity Type:Individual
Prefix:
First Name:LIJI
Middle Name:
Last Name:JOHN
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 1:2611 DRAKENSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0183
Mailing Address - Country:US
Mailing Address - Phone:956-270-1650
Mailing Address - Fax:
Practice Address - Street 1:801 E NOLANA AVE STE 13A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6117
Practice Address - Country:US
Practice Address - Phone:956-686-2700
Practice Address - Fax:956-686-2708
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1111712OtherTEXAS BOARD OF NURSING