Provider Demographics
NPI:1568626661
Name:BROLL, LIZA COLETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:COLETTE
Last Name:BROLL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MEMORIAL AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:301-723-4965
Mailing Address - Fax:301-723-4983
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-723-4965
Practice Address - Fax:301-723-4983
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134724163W00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse