Provider Demographics
NPI:1487889846
Name:LIEBER, CAROL LEE (NP-C)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:LIEBER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:STAFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:31115 HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906-3133
Mailing Address - Country:US
Mailing Address - Phone:619-478-5254
Mailing Address - Fax:619-478-9164
Practice Address - Street 1:31115 HIGHWAY 94
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906-3133
Practice Address - Country:US
Practice Address - Phone:619-478-5254
Practice Address - Fax:619-478-9164
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3323363LF0000X
CANP20849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily