Provider Demographics
NPI:1750706628
Name:DE BENEDET, LISA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DE BENEDET
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNA
Other - Last Name:DE BENEDET-MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:2038 DIAMOND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1939
Mailing Address - Country:US
Mailing Address - Phone:281-531-9974
Mailing Address - Fax:281-531-9974
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:SUITE #130
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:281-379-2340
Practice Address - Fax:281-392-7814
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656650363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care