=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326428293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA LISCIO APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2015
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 W JOHN ST STE B
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89703-8829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-445-5080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 W JOHN ST STE B
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89703-8829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-445-5080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN002632
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN40348
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------