Provider Demographics
NPI:1356347496
Name:LEIBEL, DEBRA K (CNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:LEIBEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523-0358
Mailing Address - Country:US
Mailing Address - Phone:605-775-2631
Mailing Address - Fax:605-775-2564
Practice Address - Street 1:809 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523-2065
Practice Address - Country:US
Practice Address - Phone:605-775-2631
Practice Address - Fax:605-775-2564
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-10-25
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-01
Provider Licenses
StateLicense IDTaxonomies
SDR016114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4997517OtherBLUE CROSS OF SD
SD6823700Medicaid
SD4997517OtherBLUE CROSS OF SD
SD6823700Medicaid