Healthcare Provider Details

I. General information

NPI: 1619849346
Provider Name (Legal Business Name): LIZA SUE ANN DE VENECIA LIGAYO MORA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2729
US

IV. Provider business mailing address

2430 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2729
US

V. Phone/Fax

Practice location:
  • Phone: 702-247-9994
  • Fax: 702-651-9995
Mailing address:
  • Phone: 702-247-9994
  • Fax: 702-651-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number842861
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: