Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 431163 | NY |
NPI | 1023532371 |
---|---|
Provider Name | Nicole Alexandra Lieber |
First Address | Long Island City, NY 11101-5948 |
Second Address | Long Island City, NY 11101-5948 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2017 |
Last Update Date | 18/04/2019 |