Healthcare Provider Details

I. General information

NPI: 1407783426
Provider Name (Legal Business Name): LEIGHANN LIBERTUCCI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 FIDDLERS LN
LATHAM NY
12110-5349
US

IV. Provider business mailing address

91 FIDDLERS LN
LATHAM NY
12110-5349
US

V. Phone/Fax

Practice location:
  • Phone: 518-785-8591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number991629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: