Provider Demographics
NPI:1598178998
Name:SCHAUBROECK, LISA MARIE (AGNP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:SCHAUBROECK
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:PEMPEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6931 COUNTY ROAD 289
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-4036
Mailing Address - Country:US
Mailing Address - Phone:979-647-4820
Mailing Address - Fax:
Practice Address - Street 1:668 W BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:TX
Practice Address - Zip Code:77486-2616
Practice Address - Country:US
Practice Address - Phone:979-345-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125646363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology