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Individual

JAYCIE N LIEBENDORFER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN, CNP

Contact information

Practice address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2100
(309) 664-3130
(309) 664-3258
Mailing address
1701 E COLLEGE AVE, BLOOMINGTON, IL 61704-2101
(309) 664-3130
(309) 664-3258

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209008461
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209008461
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209008461
IL

Other

Enumeration date
11/05/2010
Last updated
02/25/2025
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