Provider Demographics
NPI:1346213089
Name:CANOWITZ, LIZA BENNETT (CNM)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:BENNETT
Last Name:CANOWITZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 JASONWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2456
Mailing Address - Country:US
Mailing Address - Phone:614-268-8800
Mailing Address - Fax:614-447-8876
Practice Address - Street 1:921 JASONWAY AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2456
Practice Address - Country:US
Practice Address - Phone:614-268-8800
Practice Address - Fax:614-447-8876
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.08629367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2660740Medicaid
OHNM03401Medicare UPIN