Provider Demographics
NPI:1285495325
Name:LIWANAG, MARIA LIZA YUTUC (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARIA LIZA
Middle Name:YUTUC
Last Name:LIWANAG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 RARITAN PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3457
Mailing Address - Country:US
Mailing Address - Phone:714-213-0779
Mailing Address - Fax:
Practice Address - Street 1:4040 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0810
Practice Address - Country:US
Practice Address - Phone:702-463-0300
Practice Address - Fax:702-463-0301
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV841657164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty