Individual
IAN M LIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
600 COMMERCE BLVD, STROUDSBURG, PA 18360-6214
(570) 424-7390
(570) 424-7395
Mailing address
2100 MACK BLVD FL 4, ALLENTOWN, PA 18103-5622
(484) 629-2282
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP024724
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP024724
STATE LICENSE
PA
Enumeration date
11/16/2021
Last updated
01/06/2025
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