Basic Information
| Provider Information | |||||||||
| NPI: | 1932817269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURSO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2106 INTERNATIONAL AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776321410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098833950 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 350 PINE ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777012437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098334004 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1082935 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.