Provider Demographics
NPI:1801877360
Name:LISKA, STEPHANIE (CNM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LISKA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 E EGBERT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2475
Mailing Address - Country:US
Mailing Address - Phone:303-655-3000
Mailing Address - Fax:303-655-3001
Practice Address - Street 1:1860 E EGBERT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2475
Practice Address - Country:US
Practice Address - Phone:303-655-3000
Practice Address - Fax:303-655-3001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO96472367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99424771Medicaid
CO530888Medicare ID - Type Unspecified