Provider Demographics
NPI:1497277222
Name:DAMURA, LISA ALANE (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ALANE
Last Name:DAMURA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
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 3041
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-3077
Mailing Address - Country:US
Mailing Address - Phone:512-710-0551
Mailing Address - Fax:512-717-6337
Practice Address - Street 1:5524 BEE CAVES RD STE H2
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5246
Practice Address - Country:US
Practice Address - Phone:512-710-0551
Practice Address - Fax:512-717-6337
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134477363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX377451502Medicaid