Provider Demographics
NPI:1124359500
Name:LIEBZEIT, JOHN A (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:LIEBZEIT
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 1:411 JEPSON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-8400
Mailing Address - Country:US
Mailing Address - Phone:715-823-5110
Mailing Address - Fax:
Practice Address - Street 1:411 JEPSON RD
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-8400
Practice Address - Country:US
Practice Address - Phone:715-823-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171149-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health