Provider Demographics
NPI:1750367314
Name:JEAN GISLER
Entity type:Organization
Organization Name:JEAN GISLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GISLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:361-575-4100
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3276
Mailing Address - Country:US
Mailing Address - Phone:361-576-3680
Mailing Address - Fax:361-576-4219
Practice Address - Street 1:3002 SAM HOUSTON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2682
Practice Address - Country:US
Practice Address - Phone:361-575-4100
Practice Address - Fax:361-575-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX427272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024LHOtherBCBS OF TX #
TX167309702Medicaid
TX167309702Medicaid