Provider Demographics
NPI:1437465101
Name:MALAMUTE, LIZA SARAH (RN, CDE, CFCN)
Entity Type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:SARAH
Last Name:MALAMUTE
Suffix:
Gender:F
Credentials:RN, CDE, CFCN
Other - Prefix:MRS
Other - First Name:LIZA
Other - Middle Name:SARAH
Other - Last Name:VENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:1408 19TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5903
Mailing Address - Country:US
Mailing Address - Phone:907-451-6682
Mailing Address - Fax:907-459-3976
Practice Address - Street 1:1408 19TH AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5903
Practice Address - Country:US
Practice Address - Phone:907-451-6682
Practice Address - Fax:907-459-3976
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK17910163W00000X
AK2221-0458163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator