Provider Demographics
NPI:1629224035
Name:LISING, MA.RIZA
Entity Type:Individual
Prefix:
First Name:MA.RIZA
Middle Name:
Last Name:LISING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8710 CORONA AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3900
Mailing Address - Country:US
Mailing Address - Phone:718-592-6609
Mailing Address - Fax:
Practice Address - Street 1:8710 CORONA AVE FL 3
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-3900
Practice Address - Country:US
Practice Address - Phone:718-592-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305317363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health