Provider Demographics
NPI:1023895646
Name:AKA, LIZAN ATUD
Entity type:Individual
Prefix:
First Name:LIZAN ATUD
Middle Name:
Last Name:AKA
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 1:8619 ANNAPOLIS RD APT 102
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3104
Mailing Address - Country:US
Mailing Address - Phone:240-423-8675
Mailing Address - Fax:
Practice Address - Street 1:8619 ANNAPOLIS RD APT 102
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3104
Practice Address - Country:US
Practice Address - Phone:240-423-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide