Basic Information
| Provider Information | |||||||||
| NPI: | 1629632427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANDHI | ||||||||
| FirstName: | LISHA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 779 NORMANDY ST STE 114 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770153441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134538900 | ||||||||
| FaxNumber: | 7186402713 | ||||||||
| Practice Location | |||||||||
| Address1: | 779 NORMANDY ST STE 114 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770153441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134538900 | ||||||||
| FaxNumber: | 7186402713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2019 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP141076 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP141076 | 01 | TX | STATE LICENSE | OTHER |