Basic Information
| Provider Information | |||||||||
| NPI: | 1235362781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LISS | ||||||||
| FirstName: | ROZA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15825 SHADY GROVE RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018699776 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15825 SHADY GROVE RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208504015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018699776 | ||||||||
| FaxNumber: | 7185136285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2009 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | R206181 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 163WH0200X | 520164 | NY | N | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.