Provider Demographics
NPI:1629632427
Name:GANDHI, LISHA S (FNP)
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:S
Last Name:GANDHI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 NORMANDY ST STE 114
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3441
Mailing Address - Country:US
Mailing Address - Phone:713-453-8900
Mailing Address - Fax:718-640-2713
Practice Address - Street 1:779 NORMANDY ST STE 114
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3441
Practice Address - Country:US
Practice Address - Phone:713-453-8900
Practice Address - Fax:718-640-2713
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP141076OtherSTATE LICENSE