Provider Demographics
NPI:1699275560
Name:ELROD, LISA DANIELLE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DANIELLE
Last Name:ELROD
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 1:1743 FARM ROAD 1735
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-8397
Mailing Address - Country:US
Mailing Address - Phone:903-285-4682
Mailing Address - Fax:
Practice Address - Street 1:1743 FARM ROAD 1735
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-8397
Practice Address - Country:US
Practice Address - Phone:903-285-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173998164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse