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NPI Code Detail

MEDICARE: TIARA LISTON

MEDICARE: TIARA LISTON
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1467156182
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIARA LISTON
Provider Business Mailing Address
First Line : 3109 MARTIN LUTHER KING JR AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-1573
Country : US
Telephone Number : 202-800-4433
Fax Number :
Provider Business Practice Location Address
First Line : 3109 MARTIN LUTHER KING JR AVE SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-1573
Country : US
Telephone Number : 202-800-4433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2023
Last Update Date : 03/28/2023

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Directions to “ TIARA LISTON ” Practice Location

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