Provider Demographics
NPI:1942977806
Name:MOORMAN, LIZA MARIA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:MARIA
Last Name:MOORMAN
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 1:1621 MCCAUSLAND DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5350
Mailing Address - Country:US
Mailing Address - Phone:440-915-7513
Mailing Address - Fax:
Practice Address - Street 1:1621 MCCAUSLAND DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5350
Practice Address - Country:US
Practice Address - Phone:440-915-7513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH345659163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse