Basic Information
| Provider Information | |||||||||
| NPI: | 1083251250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIZARDO | ||||||||
| FirstName: | ROSEMARIE | ||||||||
| MiddleName: | SALACUP | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E SILVERADO RANCH BLVD STE 170 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891837518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022406482 | ||||||||
| FaxNumber: | 7028040957 | ||||||||
| Practice Location | |||||||||
| Address1: | 2839 SAINT ROSE PKWY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890524848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022406482 | ||||||||
| FaxNumber: | 7022408529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2019 | ||||||||
| LastUpdateDate: | 05/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 825338 | NV | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 363LF0000X | 825338 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 825338 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.