| Doctor Name: | JENNIFER A LIEBOLD |
| NPI Number: | 1063665156 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.S.N., R.N. |
| License Number: | RN516456L |
| Business Practice Address: | 807 Lawn Ave Sellersville, PA - 189601549 |
| Business Phone Number: | 2152576551 |
| Business Fax Number: | 2152579347 |
| Mailing Address: | 807 Lawn Ave, P.o. Box 32 SELLERSVILLE |
| State: | PA |
| Postal Code: | 189601549 |
| Phone Number: | 2152576551 |
| Fax Number: | 2152579347 |
| NPI Enumeration Date: | 11/03/2008 |
| NPI Last Update Date: | 11/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WA0400X |
| License Number: | RN516456L |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |