Individual
LISA RENE MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CPNP
Contact information
Practice address
2127 IH 10W, SUITE 104, SAN ANTONIO, TX 78257-3154
(210) 899-6856
(210) 750-3056
Mailing address
2127 IH 10W, SUITE 104, SAN ANTONIO, TX 78257-3154
(210) 899-6856
(210) 750-3056
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
AP112503
TX
363LP0200X
Pediatric Nurse Practitioner
583557
TX
363LP0200X
Pediatric Nurse Practitioner
AP112503
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161323408
—
TX
01
—
161323409
MEDICAID - CSHCN
TX
01
—
806N39
BCBS
TX
Enumeration date
10/18/2006
Last updated
07/27/2023
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