Healthcare Provider Details

I. General information

NPI: 1437195807
Provider Name (Legal Business Name): NIECA P. LIETZAN MSN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S BEDFORD ST
GEORGETOWN DE
19947-1852
US

IV. Provider business mailing address

14832 WOODY RD
LAUREL DE
19956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-5225
  • Fax: 302-856-5061
Mailing address:
  • Phone: 302-875-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLH-0000116
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: