Provider Demographics
NPI:1700420403
Name:LIEBER, LINDA JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
Last Name:LIEBER
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 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-351-6986
Mailing Address - Fax:602-266-9025
Practice Address - Street 1:1255 W BASELINE RD STE 138A
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5821
Practice Address - Country:US
Practice Address - Phone:623-776-3006
Practice Address - Fax:602-266-9025
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP235666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily