Provider Demographics
NPI:1073790358
Name:LISENBY, THERESA RAE (RN,CEO, INSTRUCTOR)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:RAE
Last Name:LISENBY
Suffix:
Gender:F
Credentials:RN,CEO, INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 FM 3094
Mailing Address - Street 2:
Mailing Address - City:SCURRY
Mailing Address - State:TX
Mailing Address - Zip Code:75158-4915
Mailing Address - Country:US
Mailing Address - Phone:972-452-3337
Mailing Address - Fax:972-452-3331
Practice Address - Street 1:7471 FM 3094
Practice Address - Street 2:
Practice Address - City:SCURRY
Practice Address - State:TX
Practice Address - Zip Code:75158-4915
Practice Address - Country:US
Practice Address - Phone:972-452-3337
Practice Address - Fax:972-452-3331
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572628163WM0705X
174400000X, 225500000X, 225800000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No174400000XOther Service ProvidersSpecialist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program