Provider Demographics
NPI:1184933616
Name:WEILER, LISA D (LSA; CSFA; LVN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:WEILER
Suffix:
Gender:F
Credentials:LSA; CSFA; LVN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:KOLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14600 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77378-4044
Mailing Address - Country:US
Mailing Address - Phone:936-203-1100
Mailing Address - Fax:936-856-3598
Practice Address - Street 1:14600 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77378-4044
Practice Address - Country:US
Practice Address - Phone:936-856-3598
Practice Address - Fax:936-856-3598
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188120OtherLVN
203311OtherCSFA
TXSA00913OtherLSA