Healthcare Provider Details

I. General information

NPI: 1346798360
Provider Name (Legal Business Name): MAGGIE LISTHAUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGGIE DWECK

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 W 56TH ST SUITE 1003
NEW YORK NY
10019-3800
US

IV. Provider business mailing address

156 W 56TH ST SUITE 1003
NEW YORK NY
10019-3800
US

V. Phone/Fax

Practice location:
  • Phone: 844-337-6362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3410441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: