Provider Demographics
NPI:1669682373
Name:MCCAFFERTY, LIZA TULIO (MS)
Entity Type:Individual
Prefix:MS
First Name:LIZA
Middle Name:TULIO
Last Name:MCCAFFERTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 E BLUE LUPINE DR.
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6445
Mailing Address - Country:US
Mailing Address - Phone:907-745-8655
Mailing Address - Fax:907-745-8654
Practice Address - Street 1:6445 E BLUE LUPINE DR.
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6445
Practice Address - Country:US
Practice Address - Phone:907-745-8655
Practice Address - Fax:907-745-8654
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK74772171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK74772Medicaid