Individual
LISA JILL VANDIEMEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
615 CLINIC DR, LONGVIEW, TX 75605-5172
(903) 571-4656
(903) 881-1994
Mailing address
12197 CROSS FENCE TRL, TYLER, TX 75706-4241
(903) 571-4656
(903) 881-1994
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
684452
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP119904
TX
Other
Enumeration date
02/01/2011
Last updated
05/02/2024
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