Provider Demographics
NPI:1013192335
Name:LIETAR, SHARON LEE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:LIETAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 S US HIGHWAY 191
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-9559
Mailing Address - Country:US
Mailing Address - Phone:928-348-8891
Mailing Address - Fax:
Practice Address - Street 1:5810 S US HIGHWAY 191
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-9559
Practice Address - Country:US
Practice Address - Phone:928-348-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ511497385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ511497OtherLICENSE