Provider Demographics
NPI:1861065302
Name:WERTZ, LISA MICHELLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:WERTZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:WERTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2 DOCTOR CIR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5050
Mailing Address - Country:US
Mailing Address - Phone:190-375-3232
Mailing Address - Fax:903-234-2979
Practice Address - Street 1:2 DOCTOR CIR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5050
Practice Address - Country:US
Practice Address - Phone:190-375-3232
Practice Address - Fax:903-234-2979
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily