=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770252603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIANA RODRIGUEZ RUNYON APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2021
-----------------------------------------------------
Last Update Date | 12/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1821 WIRT RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77055-2406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-468-9004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8021 PETERS RD APT 147
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-853-9862
-----------------------------------------------------
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 | 11028356
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------