Provider Demographics
NPI:1598091787
Name:LANCE, LISA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:LANCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 HULEN ST.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107
Mailing Address - Country:US
Mailing Address - Phone:817-688-3230
Mailing Address - Fax:817-569-5249
Practice Address - Street 1:1200 CIRCLE DR
Practice Address - Street 2:101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-8112
Practice Address - Country:US
Practice Address - Phone:817-688-3230
Practice Address - Fax:817-569-5249
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626812163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse