JOHN T. LIESSE RN NPI 1548405038

NPI Information

NPI: 1548405038
Provider Name: JOHN T. LIESSE, RN
Classification: Registered Nurse - 163WD0400X
Entity Type: Individual

Specialization: Diabetes Educator

Address:
US HWY 491 NORTH
SHIPROCK, NM
ZIP 87420
Phone: (505) 368-6401
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John T. Liesse, RN is a diabetes educator registered nurse in Shiprock, NM. John T. Liesse, RN NPI is 1548405038. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

US HWY 491 NORTH
SHIPROCK, NM
ZIP 87420
Phone: (505) 368-6401
Fax: (505) 368-6431

The enumeration date for this NPI number is 12/11/2008 and was last updated on 12/11/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		R40513	NEW MEXICO	No
2	163WD0400X	Registered Nurse	Diabetes Educator	R40513	NEW MEXICO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	320059	MEDICARE OSCAR/CERTIFICATION	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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