Provider Demographics
NPI:1730287525
Name:HUTCHENS, LISA WURZEL (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:WURZEL
Last Name:HUTCHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:WURZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6034 W COURTYARD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-5064
Mailing Address - Country:US
Mailing Address - Phone:512-328-2266
Mailing Address - Fax:512-328-2055
Practice Address - Street 1:345 CYPRESS CREEK RD
Practice Address - Street 2:STE 104
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4483
Practice Address - Country:US
Practice Address - Phone:512-336-2777
Practice Address - Fax:512-336-2778
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBH5001730OtherDEA