Provider Demographics
NPI:1659319242
Name:LIZMI, MEREDITH C (CRNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:C
Last Name:LIZMI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST STE 3105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-2600
Practice Address - Fax:443-849-2620
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR152870363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKJ31/621909-03OtherCAREFIRST MD-GBMC
MD403735900Medicaid
MDKT93ST / 621909-01OtherBC / BS OF MD
MDS131/0004OtherCAREFIRST REGIONAL-GBMC
MDS186 / 0066OtherBLUECHOICE
MD704LQ544Medicare PIN
MD165L / H336Medicare PIN