Individual
MS. LISA R. LOSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, CNOR, CRNFA
Contact information
Practice address
1100 E LAKE ST, SUITE 230, TYLER, TX 75701-3343
(903) 539-0230
(903) 597-3015
Mailing address
PO BOX 1848, 519 SUNNYSIDE DRIVE, CHANDLER, TX 75758-1848
(903) 849-6475
(903) 849-6475
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
613274
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N8064, 8R5610
752930949, 201844225
TX
Enumeration date
11/02/2006
Last updated
07/08/2007
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