Provider Demographics
NPI:1124151337
Name:LEIBFARTH, MICHELE ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANNE
Last Name:LEIBFARTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:LEIBFARTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:210 KINGSLEY LN
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-6756
Mailing Address - Country:US
Mailing Address - Phone:402-857-2300
Mailing Address - Fax:
Practice Address - Street 1:110 S VISITING EAGLE ST
Practice Address - Street 2:
Practice Address - City:NIOBRARA
Practice Address - State:NE
Practice Address - Zip Code:68760-7201
Practice Address - Country:US
Practice Address - Phone:402-857-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024000163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care