Individual
LISA HAVICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246
(214) 820-0111
Mailing address
3500 GASTON AVE, DALLAS, TX 75246-2088
(214) 820-0111
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP129579
TX
Other
Enumeration date
01/04/2016
Last updated
11/15/2019
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