Individual
MS. LISA IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
450 EL DORADO BLVD, # 720, WEBSTER, TX 77598-2317
(281) 282-7027
(281) 862-9148
Mailing address
PO BOX 2049, CHANNELVIEW, TX 77530-8049
(281) 282-7027
(281) 862-9148
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/25/2010
Last updated
03/25/2010
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