Individual
LISA DANIELE BOUILLION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
7201 MANCHACA RD, AUSTIN, TX 78745-5283
(512) 443-3577
(512) 445-6027
Mailing address
7201 MANCHACA RD STE B, AUSTIN, TX 78745-5284
(512) 443-3577
(512) 445-6027
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP1407100
TX
Other
Enumeration date
03/06/2019
Last updated
03/06/2019
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