Provider Demographics
NPI:1407285158
Name:HORN, MARIA LIZA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA LIZA
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 RIVERLEIGH AVE UNIT A5
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3605
Mailing Address - Country:US
Mailing Address - Phone:631-566-7388
Mailing Address - Fax:
Practice Address - Street 1:165 OLIVER ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-6216
Practice Address - Country:US
Practice Address - Phone:631-727-7006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY615868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse