Provider Demographics
NPI:1700148509
Name:LEIBOLD, SUSAN RUTH (RN, MSSN, CNS-P)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RUTH
Last Name:LEIBOLD
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Gender:F
Credentials:RN, MSSN, CNS-P
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Mailing Address - Street 1:2222 WELBORN ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3924
Mailing Address - Country:US
Mailing Address - Phone:214-559-7860
Mailing Address - Fax:214-559-7835
Practice Address - Street 1:2222 WELBORN ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3924
Practice Address - Country:US
Practice Address - Phone:214-559-7860
Practice Address - Fax:214-559-7835
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
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Provider Licenses
StateLicense IDTaxonomies
TX624693364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics