Provider Demographics
NPI:1386154995
Name:BASILIO, LENNIE LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:LENNIE
Middle Name:LYNN
Last Name:BASILIO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8754 SPRING CYPRESS RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3135
Mailing Address - Country:US
Mailing Address - Phone:281-257-4320
Mailing Address - Fax:
Practice Address - Street 1:8754 SPRING CYPRESS RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3135
Practice Address - Country:US
Practice Address - Phone:281-257-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily