Provider Demographics
NPI:1962140079
Name:TANGNEY, LIZA A
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:A
Last Name:TANGNEY
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 1:13 PHOENIX ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2311
Mailing Address - Country:US
Mailing Address - Phone:774-696-1252
Mailing Address - Fax:
Practice Address - Street 1:13 PHOENIX ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2311
Practice Address - Country:US
Practice Address - Phone:774-696-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist