| NPI | 1194058933 |
|---|---|
| Former Name | TIFFANY ANN LISKO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 2416) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: Certificate #1063424) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2009-09-11 |