Provider Demographics
NPI:1508392952
Name:LIEBLANG, MELANIE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:LIEBLANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 FIELD OAK DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8202
Mailing Address - Country:US
Mailing Address - Phone:631-742-2306
Mailing Address - Fax:919-336-4363
Practice Address - Street 1:6602 KNIGHTDALE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6526
Practice Address - Country:US
Practice Address - Phone:919-747-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004556363LF0000X
NY340431363LF0000X
GARN299842363LF0000X
DCRN1057625363LF0000X
TX1066221363LF0000X
TN30597363LF0000X
VA0024178432363LF0000X
MDAC003072363LF0000X
NC5009480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily