Healthcare Provider Details

I. General information

NPI: 1841543808
Provider Name (Legal Business Name): LIOUDMILA PLISS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6631 MAIN ST STE 2
WILLIAMSVILLE NY
14221-5934
US

IV. Provider business mailing address

6631 MAIN ST STE 2
WILLIAMSVILLE NY
14221-5934
US

V. Phone/Fax

Practice location:
  • Phone: 716-428-5505
  • Fax: 716-707-3935
Mailing address:
  • Phone: 716-428-5505
  • Fax: 716-428-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF306218-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: