Basic Information
| Provider Information | |||||||||
| NPI: | 1649676370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LISKOVA | ||||||||
| FirstName: | DANA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 MARYLAND RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154814143 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3941 COMMERCE AVE | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154814000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2014 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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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 | 282NC0060X | N | Hospitals | General Acute Care Hospital | Critical Access | 363LA2100X | SP013816 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2200X | SP013817 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | SP013816 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.