Individual
JOHN T. LIESSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R40513
NM
163WD0400X
Diabetes Educator Registered Nurse
Primary
R40513
NM
Other
Enumeration date
12/11/2008
Last updated
12/11/2008
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