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General NPI Number Information
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NPI Number | 1902921018
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Entity Type | Individual
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Provider Name | MARYJO LISTON RN
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12 PETRA LN
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City | ALBANY
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State | NY
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Zip | 12205-4973
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Country | US
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Telephone | 518-452-0445
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Fax | 518-452-3489
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Provider Business Mailing Address
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Address Line | 1802 S PARKWOOD DR
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City | CLIFTON PARK
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State | NY
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Zip | 12065-2550
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Country | US
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Telephone | 518-371-4999
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 481540
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License Number State | NY
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