Healthcare Provider Details

I. General information

NPI: 1396878005
Provider Name (Legal Business Name): YVONNE MARIE LISWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

24690 PEALIQUOR RD
DENTON MD
21629-2301
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-7249
  • Fax:
Mailing address:
  • Phone: 410-479-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR135787
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: