Doctor Name: | MISS STACIE NOEL LIEBELT |
NPI Number: | 1295779387 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | F.N P. |
License Number: | 14950 |
Business Practice Address: | 2603 Patterson Rd Suite 2 Riverbank, CA - 953673407 |
Business Phone Number: | 2098697400 |
Business Fax Number: | |
Mailing Address: | 2603 Patterson Rd, Suite 2 RIVERBANK |
State: | CA |
Postal Code: | 953673407 |
Phone Number: | 2098697400 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2006 |
NPI Last Update Date: | 09/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 14950 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |