Provider Demographics
NPI:1972687275
Name:SRINIVASAN, LAKSHMI (FNP)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:SRINIVASAN
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:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-0667
Mailing Address - Country:US
Mailing Address - Phone:903-683-3421
Mailing Address - Fax:
Practice Address - Street 1:1601 NORTH DICKINSON
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-0318
Practice Address - Country:US
Practice Address - Phone:903-683-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ45372Medicare UPIN
8D5387Medicare ID - Type Unspecified