Provider Demographics
NPI:1790915775
Name:LISMAN, MEAGHAN RATHVON (RN-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:RATHVON
Last Name:LISMAN
Suffix:
Gender:F
Credentials:RN-C, FNP-BC
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:KELLY
Other - Last Name:RATHVON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 S INTERSTATE 35
Mailing Address - Street 2:STE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5758
Mailing Address - Country:US
Mailing Address - Phone:512-900-5844
Mailing Address - Fax:844-965-9421
Practice Address - Street 1:121 N NYES RD
Practice Address - Street 2:SUITE F
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3247
Practice Address - Country:US
Practice Address - Phone:717-214-6545
Practice Address - Fax:717-531-0639
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139719363LF0000X
PASP012598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily