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General NPI Number Information
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NPI Number | 1043506132
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Entity Type | Individual
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Provider Name | LISA MARIE LICCIARDI
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Gender | Female
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 82 HILLSIDE RD
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City | PENROSE
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State | NC
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Zip | 28766-8783
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Country | US
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Telephone | 828-877-4076
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Fax |
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Provider Business Mailing Address
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Address Line | 508 ELM BEND RD
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City | BREVARD
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State | NC
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Zip | 28712-9577
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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