Provider Demographics
NPI:1679859896
Name:LISS, AMY REBECCA (MSN, RN, EDD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:REBECCA
Last Name:LISS
Suffix:
Gender:F
Credentials:MSN, RN, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 AMSTERDAM AVE
Mailing Address - Street 2:APT. 1017
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 AMSTERDAM AVE
Practice Address - Street 2:APT. 1017
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6604
Practice Address - Country:US
Practice Address - Phone:314-651-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201901301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse