Individual
ETHELEEN OLIVIA LENGYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3604 LIVE OAK ST, SUITE 100, DALLAS, TX 75204-6168
(214) 358-2300
(214) 366-6330
Mailing address
1505 LBJ FWY STE 700, DALLAS, TX 75234-6065
(214) 358-2300
(214) 579-6941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00047
TX
363AM0700X
Medical Physician Assistant
PA00047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00047
TX MEDICAL LICENSE
TX
Enumeration date
08/17/2006
Last updated
12/15/2023
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