Provider Demographics
NPI:1942764717
Name:VARGHESE, LIZAMMA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LIZAMMA
Middle Name:
Last Name:VARGHESE
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 1:3601 ALEXANDRITE WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2438
Mailing Address - Country:US
Mailing Address - Phone:512-989-2372
Mailing Address - Fax:
Practice Address - Street 1:3601 ALEXANDRITE WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2438
Practice Address - Country:US
Practice Address - Phone:512-989-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily