Healthcare Provider Details

I. General information

NPI: 1528408788
Provider Name (Legal Business Name): TERI ANN LIESER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4974 HIGBEE AVE NW STE 209
CANTON OH
44718-2562
US

IV. Provider business mailing address

848 34TH ST NW APT 6
CANTON OH
44709-2974
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-4553
  • Fax: 330-493-3761
Mailing address:
  • Phone: 330-232-4709
  • Fax: 330-493-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberCOA.14489-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: