Provider Demographics
NPI:1720383094
Name:LEIBY, SANDRA LEE (DNP)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:LEIBY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:THORNTON
Other - Last Name:LEIBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:PO BOX 2106
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1098
Mailing Address - Country:US
Mailing Address - Phone:978-686-9739
Mailing Address - Fax:
Practice Address - Street 1:9 CRESTSHIRE LN
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1001
Practice Address - Country:US
Practice Address - Phone:978-686-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN251274363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health