Provider Demographics
NPI:1366733701
Name:NORDMEYER, DARISSA CHERIE (LSA)
Entity type:Individual
Prefix:
First Name:DARISSA
Middle Name:CHERIE
Last Name:NORDMEYER
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S LAKELINE BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2735
Mailing Address - Country:US
Mailing Address - Phone:512-381-4272
Mailing Address - Fax:512-381-4275
Practice Address - Street 1:201 S LAKELINE BLVD STE 405
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2735
Practice Address - Country:US
Practice Address - Phone:512-381-4272
Practice Address - Fax:512-381-4275
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00393246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00393OtherLICENSED SURGICAL ASSISTANT