MEDICARE: MRS. CATHY JO LEIBY R.N., C.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246W00000X	Cardiology Technician	RN200256L	PA

General Provider Information

NPI Number	:	1942336540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHY JO LEIBY R.N., C.S.

Provider Business Mailing Address
First Line	:	520 FRANKLIN RD
Second Line	:
City	:	BECHTELSVILLE
State	:	PA
Zip	:	19505-9246
Country	:	US
Telephone Number	:	610-369-0680
Fax Number	:	610-369-3657

Provider Business Practice Location Address
First Line	:	4230 CRUMS MILL RD
Second Line	:	SUITE 201
City	:	HARRISBURG
State	:	PA
Zip	:	17112-2898
Country	:	US
Telephone Number	:	800-828-7711
Fax Number	:	717-657-9088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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