Provider Demographics
NPI:1346073491
Name:LIEBL, MADALYN RAE (PA-C)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:RAE
Last Name:LIEBL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MADALYN
Other - Middle Name:RAE
Other - Last Name:HEILING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7516 S BELL CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5909
Mailing Address - Country:US
Mailing Address - Phone:507-430-9895
Mailing Address - Fax:
Practice Address - Street 1:6100 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6029
Practice Address - Country:US
Practice Address - Phone:605-504-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant