Individual
RYAN J LIESKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
104 W SENECA ST, RAVENNA, NE 68869-1363
(308) 452-3203
(308) 452-3795
Mailing address
104 W SENECA ST, RAVENNA, NE 68869-1363
(308) 452-3203
(308) 452-3795
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
767
NE
Other
Enumeration date
05/17/2006
Last updated
05/05/2010
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