Provider Demographics
NPI:1548754716
Name:MOTZER, LISA MARIN (LPN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIN
Last Name:MOTZER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:110 LAUREN TICE RD
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4159
Mailing Address - Country:US
Mailing Address - Phone:845-532-0007
Mailing Address - Fax:
Practice Address - Street 1:110 LAUREN TICE RD
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4159
Practice Address - Country:US
Practice Address - Phone:845-532-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290585-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse