Provider Demographics
NPI:1699517219
Name:WASSON, LIYAH MARIE
Entity type:Individual
Prefix:
First Name:LIYAH
Middle Name:MARIE
Last Name:WASSON
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 1:101 QUINCY CV
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3326
Mailing Address - Country:US
Mailing Address - Phone:501-339-8486
Mailing Address - Fax:
Practice Address - Street 1:101 QUINCY CV
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3326
Practice Address - Country:US
Practice Address - Phone:501-339-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula