Provider Demographics
NPI:1598276982
Name:LEIBOLD, SALLY (RN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:
Last Name:LEIBOLD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:KAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:930 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-1001
Mailing Address - Country:US
Mailing Address - Phone:702-383-4044
Mailing Address - Fax:
Practice Address - Street 1:930 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-1001
Practice Address - Country:US
Practice Address - Phone:702-383-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN50696163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health