Basic Information
| Provider Information | |||||||||
| NPI: | 1528073699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGLIERI | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7011 RIBELIN RANCH DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787508585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123457436 | ||||||||
| FaxNumber: | 5123467436 | ||||||||
| Practice Location | |||||||||
| Address1: | 7011 RIBELIN RANCH DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123457436 | ||||||||
| FaxNumber: | 5123467436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L3570 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 156657205 | 05 | TX | MEDICAID | 156657206 | 05 | TX | MEDICAID | L3570 | 01 | TX | TX MEDICAL LICENSE | OTHER | 60122929 | 01 | TX | DPS | OTHER | BB7777317 | 01 | TX | DEA | OTHER |