Provider Demographics
NPI:1083251250
Name:LIZARDO, ROSEMARIE SALACUP (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:SALACUP
Last Name:LIZARDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 E SILVERADO RANCH BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7518
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-804-0957
Practice Address - Street 1:2839 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4848
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:702-240-8529
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV825338208VP0014X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily