Provider Demographics
NPI:1083229520
Name:LIESKE, RICHARD STEVEN (RN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEVEN
Last Name:LIESKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 STAGECOACH PASS
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-5114
Mailing Address - Country:US
Mailing Address - Phone:845-532-2267
Mailing Address - Fax:
Practice Address - Street 1:152 STAGECOACH PASS
Practice Address - Street 2:
Practice Address - City:STORMVILLE
Practice Address - State:NY
Practice Address - Zip Code:12582-5114
Practice Address - Country:US
Practice Address - Phone:845-532-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY416089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse