MEDICARE: MARIE LISSADE

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	650783	NY

General Provider Information

NPI Number	:	1982950317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE LISSADE

Provider Business Mailing Address
First Line	:	6 MURIN ST.
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977
Country	:	US
Telephone Number	:	845-290-5187
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 MURIN ST
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-4841
Country	:	US
Telephone Number	:	845-290-5187
Fax Number	:

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

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	08/03/2012

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Directions to “ MARIE LISSADE ” Practice Location

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