MEDICARE: MRS. LISA MARIE MRZENA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	130269	AK
2	163W00000X	Registered Nurse	6593775-3102	UT
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6593775-3102	UT

General Provider Information

NPI Number	:	1053645770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE MRZENA APRN

Provider Business Mailing Address
First Line	:	PO BOX 876023
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-6023
Country	:	US
Telephone Number	:	907-203-1590
Fax Number	:	435-359-9580

Provider Business Practice Location Address
First Line	:	290 N WILLOW ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7042
Country	:	US
Telephone Number	:	435-703-9647
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	10/17/2024

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