Provider Demographics
NPI:1225259146
Name:LEBER, ALICE R (APRN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:LEBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHESTNUT TREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1173
Mailing Address - Country:US
Mailing Address - Phone:203-881-0501
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4237
Practice Address - Country:US
Practice Address - Phone:203-262-1911
Practice Address - Fax:203-262-9434
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005288B163WE0003X
CT003710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500018096OtherRR MEDICARE #
PA500018096OtherRR MEDICARE #
PAP25224Medicare UPIN
CT500002275Medicare UPIN