MEDICARE: MIREYA LISS CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1047004	TX

General Provider Information

NPI Number	:	1033781067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIREYA LISS CNP

Provider Business Mailing Address
First Line	:	333 E BETHANY DR STE J130
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-3826
Country	:	US
Telephone Number	:	972-741-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E BETHANY DR STE J130
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-3826
Country	:	US
Telephone Number	:	972-741-0484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	05/30/2026

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