Provider Demographics
NPI:1588926133
Name:HUSER, LISA G (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:G
Last Name:HUSER
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 1:120 S WOODLAND BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-5445
Mailing Address - Country:US
Mailing Address - Phone:386-490-4412
Mailing Address - Fax:
Practice Address - Street 1:120 S WOODLAND BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5445
Practice Address - Country:US
Practice Address - Phone:386-490-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1755582163W00000X, 163WA0400X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management