Provider Demographics
NPI:1932817269
Name:DURSO, LISA SUZANNE (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUZANNE
Last Name:DURSO
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 INTERNATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-1410
Mailing Address - Country:US
Mailing Address - Phone:409-883-3950
Mailing Address - Fax:
Practice Address - Street 1:350 PINE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-2437
Practice Address - Country:US
Practice Address - Phone:409-833-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty