Provider Demographics
NPI:1881363018
Name:WARREN, LISA GAYLE (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:WARREN
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W FM 78
Mailing Address - Street 2:STE 203
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3553
Mailing Address - Country:US
Mailing Address - Phone:210-688-8486
Mailing Address - Fax:210-688-8487
Practice Address - Street 1:700 W FM 78
Practice Address - Street 2:STE 203
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3553
Practice Address - Country:US
Practice Address - Phone:210-784-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1033285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily