Provider Demographics
NPI:1235362781
Name:LISS, ROZA (CRNP)
Entity Type:Individual
Prefix:
First Name:ROZA
Middle Name:
Last Name:LISS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15825 SHADY GROVE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4015
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:
Practice Address - Street 1:15825 SHADY GROVE RD STE 140
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4015
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:718-513-6285
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR206181363LP2300X
NY520164163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WH0200XNursing Service ProvidersRegistered NurseHome Health