Provider Demographics
NPI:1508166810
Name:EMMENDORFER, LISA LEANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LEANN
Last Name:EMMENDORFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1762 E COMMON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6059
Mailing Address - Country:US
Mailing Address - Phone:830-730-8580
Mailing Address - Fax:830-321-1021
Practice Address - Street 1:705 LANDA ST
Practice Address - Street 2:SITE C
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6172
Practice Address - Country:US
Practice Address - Phone:830-643-0717
Practice Address - Fax:830-629-2438
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP121779363LA2200X
NC5004964363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health