Provider Demographics
NPI:1194798124
Name:SCHNEIDER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 BRODIE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5610
Mailing Address - Country:US
Mailing Address - Phone:512-462-1936
Mailing Address - Fax:833-448-3184
Practice Address - Street 1:9805 BRODIE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5610
Practice Address - Country:US
Practice Address - Phone:512-462-1936
Practice Address - Fax:512-394-9388
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2789207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042103402Medicaid
TX042103402Medicaid
TX8F2687Medicare ID - Type Unspecified