Provider Demographics
NPI:1437195807
Name:LIETZAN, NIECA P (MSN, APN)
Entity Type:Individual
Prefix:
First Name:NIECA
Middle Name:P
Last Name:LIETZAN
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14832 WOODY RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-3070
Mailing Address - Country:US
Mailing Address - Phone:302-875-0347
Mailing Address - Fax:
Practice Address - Street 1:544 S BEDFORD ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1852
Practice Address - Country:US
Practice Address - Phone:302-856-5225
Practice Address - Fax:302-856-5061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELH-0000116363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health