Provider Demographics
NPI:1285117861
Name:MUELLER-GOODRUM, LISE MARY (BSN, RN)
Entity type:Individual
Prefix:MISS
First Name:LISE
Middle Name:MARY
Last Name:MUELLER-GOODRUM
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16961 MOCKINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3723
Mailing Address - Country:US
Mailing Address - Phone:936-524-4436
Mailing Address - Fax:
Practice Address - Street 1:16961 MOCKINGBIRD CT
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-3723
Practice Address - Country:US
Practice Address - Phone:936-524-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56776163WP0808X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health