Provider Demographics
NPI:1073576112
Name:LISTON, JANET KYLE (LAC, RN)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:KYLE
Last Name:LISTON
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 GRENFELL CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7575
Mailing Address - Country:US
Mailing Address - Phone:303-665-4225
Mailing Address - Fax:
Practice Address - Street 1:1017 E S BOULDER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2547
Practice Address - Country:US
Practice Address - Phone:303-665-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO412171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
841431940OtherTIN