Provider Demographics
NPI:1043598444
Name:VAZQUEZ, LISETTE (NP, RNFA)
Entity Type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:NP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1313
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8926
Mailing Address - Country:US
Mailing Address - Phone:443-481-3201
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:8837 ROUNDHOUSE CIR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7903
Practice Address - Country:US
Practice Address - Phone:443-481-3201
Practice Address - Fax:443-481-6515
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172165363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty