Provider Demographics
NPI:1619205820
Name:STAHR, LISA L (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:STAHR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3158
Mailing Address - Country:US
Mailing Address - Phone:214-520-5743
Mailing Address - Fax:214-520-5786
Practice Address - Street 1:3500 W WHEATLAND RD
Practice Address - Street 2:WOMENS CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3460
Practice Address - Country:US
Practice Address - Phone:214-947-7281
Practice Address - Fax:214-947-0345
Is Sole Proprietor?:No
Enumeration Date:2009-11-28
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife