Provider Demographics
NPI:1962580241
Name:LOSACK, LISA R (BSN, CNOR, CRNFA)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:R
Last Name:LOSACK
Suffix:
Gender:F
Credentials:BSN, CNOR, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:519 SUNNYSIDE DRIVE
Mailing Address - City:CHANDLER
Mailing Address - State:TX
Mailing Address - Zip Code:75758-1848
Mailing Address - Country:US
Mailing Address - Phone:903-849-6475
Mailing Address - Fax:903-849-6475
Practice Address - Street 1:1100 E LAKE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3343
Practice Address - Country:US
Practice Address - Phone:903-539-0230
Practice Address - Fax:903-597-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX613274163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8064, 8R5610Other752930949, 201844225