Provider Demographics
NPI:1063991321
Name:MADDOX, LISA J (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:MADDOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-4044
Mailing Address - Country:US
Mailing Address - Phone:806-894-7872
Mailing Address - Fax:806-894-1621
Practice Address - Street 1:410 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-4044
Practice Address - Country:US
Practice Address - Phone:806-894-7872
Practice Address - Fax:806-894-1621
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724139163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health