Provider Demographics
NPI:1518232271
Name:MCBRIDE, LIZA F (LPN)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:F
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ELM ST APT A
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1120
Mailing Address - Country:US
Mailing Address - Phone:704-634-4275
Mailing Address - Fax:
Practice Address - Street 1:302 ELM ST APT A
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1120
Practice Address - Country:US
Practice Address - Phone:704-634-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267458-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse