Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NUR U 1345 | AK |
NPI | 1154664019 |
---|---|
Provider Name | Sharon Rose Liska |
First Address | Portland, OR 97208-4105 |
Second Address | Anchorage, AK 99508-4615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 17/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1621021 | (05) | AK |