Provider Demographics
NPI:1124524277
Name:CRUZ, LISET (APRN)
Entity type:Individual
Prefix:
First Name:LISET
Middle Name:
Last Name:CRUZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30805 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2482
Mailing Address - Country:US
Mailing Address - Phone:734-338-6136
Mailing Address - Fax:734-338-6195
Practice Address - Street 1:30805 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2482
Practice Address - Country:US
Practice Address - Phone:734-338-6136
Practice Address - Fax:734-338-6195
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF04180098363LF0000X
MI4704375529363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily