Individual
LISA LYNN NORTHCUTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CRNFA
Contact information
Practice address
1052 SUMMERPLACE LN, SOUTHLAKE, TX 76092-5120
(817) 379-5600
(817) 329-6688
Mailing address
1052 SUMMERPLACE LN, SOUTHLAKE, TX 76092-5120
(817) 379-5600
(817) 329-6688
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
605077
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FM31
BCBS OF TEXAS
TX
Enumeration date
10/11/2006
Last updated
08/07/2016
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