Provider Demographics
NPI:1205819075
Name:PAOLINI, LIZA ALEXIS (APRN)
Entity type:Individual
Prefix:MS
First Name:LIZA
Middle Name:ALEXIS
Last Name:PAOLINI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LIZA
Other - Middle Name:ALEXIS
Other - Last Name:PAOLINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:182 HIGH HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:182 HIGH HILL RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1906
Practice Address - Country:US
Practice Address - Phone:203-366-4242
Practice Address - Fax:203-366-4242
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003100363LF0000X, 363LP2300X
CTE59787163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236164OtherMEDICAID (PAOLINI)
CT500002176OtherMEDICARE (PAOLINI)
CT500002176OtherMEDICARE (PAOLINI)
CT004236164OtherMEDICAID (PAOLINI)
CT008039745Medicaid
CTD400000973Medicare PIN