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General NPI Number Information
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NPI Number | 1164450839
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE TISZAVARY CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2620 W FAIDLEY AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68803-4205
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Country | US
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Telephone | 402-474-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 704 S 29TH ST
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City | LINCOLN
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State | NE
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Zip | 68510-1415
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Country | US
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Telephone | 402-474-4212
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 100921
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License Number State | NE
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