Provider Demographics
NPI:1023532371
Name:LIEBER, NICOLE ALEXANDRA (NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXANDRA
Last Name:LIEBER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 50TH AVE APT 809W
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5948
Mailing Address - Country:US
Mailing Address - Phone:917-843-7784
Mailing Address - Fax:
Practice Address - Street 1:214 50TH AVE APT 809W
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5948
Practice Address - Country:US
Practice Address - Phone:917-843-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646131163W00000X
NY431163363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse