Provider Demographics
NPI:1780403626
Name:LIEDL, SEAN LILLIAN (CD (DONA))
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:LILLIAN
Last Name:LIEDL
Suffix:
Gender:F
Credentials:CD (DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-0074
Mailing Address - Country:US
Mailing Address - Phone:651-434-0686
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 74
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-0074
Practice Address - Country:US
Practice Address - Phone:651-434-0686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1450128374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula