Provider Demographics
NPI:1902601701
Name:KINGSLEY, LIZA JEANETTE
Entity type:Individual
Prefix:MS
First Name:LIZA
Middle Name:JEANETTE
Last Name:KINGSLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 TERRACE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1464
Mailing Address - Country:US
Mailing Address - Phone:458-895-1608
Mailing Address - Fax:
Practice Address - Street 1:2585 TERRACE VIEW DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-1464
Practice Address - Country:US
Practice Address - Phone:458-895-1608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201610116RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse