Individual
LIANNE SHIZUE NISHIDA-COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHW
Contact information
Practice address
400 SHADOW LANE, SUITE 104, LAS VEGAS, NV 89106
(702) 731-0909
(702) 826-4757
Mailing address
8936 SPANISH RIDGE AVENUE, CREDENTIALING, LAS VEGAS, NV 89148
(702) 731-0909
(702) 998-2991
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
CHWI-5446
NV
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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