Dondra Mary Liebman, LPN

Individual provider Active NPI Licensed Practical Nurse · Cape Vincent, NY

NPI 1023148012 · NPPES record last updated Jul 9, 2007

Key facts

NPI
1023148012
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
283861 (NY)
Practice address
29148 County Route 56
Cape Vincent, NY 13618
Phone
(315) 654-4711
NPI assigned
Mar 7, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 283861 NY Yes

Addresses

Primary practice location

29148 County Route 56
Cape Vincent, NY 13618

Mailing address

29148 County Route 56
Cape Vincent, NY 13618
Phone (315) 654-4711

Other identifiers

IdentifierTypeStateIssuer
02749526MedicaidNY

Other providers in Cape Vincent, NY

All providers in Cape Vincent, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.