=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669383006
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ALICE LISKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 BRENNER AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-706-9126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 BRENNER AVE
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-706-9126
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Registered Nurse
-----------------------------------------------------
License Number | RN.201609
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------