Provider Demographics
NPI:1740578889
Name:HALL, LISA (RN, MSN, CNS, BC)
Entity Type:Individual
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First Name:LISA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, MSN, CNS, BC
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Mailing Address - Street 1:3851 ROGER BROOKE DR
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER/DEPARTMENT OF GYN ONCOLOGY
Mailing Address - City:FT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-3170
Mailing Address - Fax:210-916-1021
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:BROOKE ARMY MEDICAL CENTER/DEPARTMENT OF GYN ONCOLOGY
Practice Address - City:FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-3170
Practice Address - Fax:210-916-1021
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
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Provider Licenses
StateLicense IDTaxonomies
TX0389777364S00000X
TX648110163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist