Provider Demographics
NPI:1871967034
Name:JAMISON, LISE ALTHOFF (CPNP)
Entity type:Individual
Prefix:
First Name:LISE
Middle Name:ALTHOFF
Last Name:JAMISON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SCHERTZ PARKWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1013
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:
Practice Address - Street 1:5000 SCHERTZ PKWY STE 202
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1403
Practice Address - Country:US
Practice Address - Phone:210-657-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129312363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics