Basic Information
| Provider Information | |||||||||
| NPI: | 1154759181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCELO | ||||||||
| FirstName: | LIZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1905 RICE ST | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805017127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704916548 | ||||||||
| FaxNumber: | 9704910268 | ||||||||
| Practice Location | |||||||||
| Address1: | COLORADO STATE UNIVERSITY | ||||||||
| Address2: | HARTSHORN HEALTH SERVICE | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704916548 | ||||||||
| FaxNumber: | 9704910268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2013 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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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 | 164W00000X | 152067 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.