MEDICARE: LISA LOUISE LIEWA RN

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	163W00000X	Registered Nurse	RN58426	NV

General Provider Information

NPI Number	:	1710867783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LOUISE LIEWA RN

Provider Business Mailing Address
First Line	:	6528 BUTTERFLY SKY ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1320
Country	:	US
Telephone Number	:	310-902-1671
Fax Number	:

Provider Business Practice Location Address
First Line	:	6528 BUTTERFLY SKY ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1320
Country	:	US
Telephone Number	:	310-902-1671
Fax Number	:

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

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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