Individual
LISA MARIA BROOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
6565 FANNIN ST, SUITE B452, HOUSTON, TX 77030-2703
(713) 441-3620
(713) 790-2082
Mailing address
6565 FANNIN ST, SUITE B452, HOUSTON, TX 77030-2703
(713) 441-3620
(713) 790-2082
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
640579
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP115304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
192155301
—
TX
05
—
192155304
—
TX
01
—
8Y3418
BLUE CROSS BLUE SHIELD
TX
01
—
P00628862
RAILROAD MEDICARE
TX
Enumeration date
09/26/2007
Last updated
07/08/2016
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