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General NPI Number Information
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NPI Number | 1578273306
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Entity Type | Individual
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Provider Name | ERICA STEPHANIE LIEDTKE PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 38 SHERIDAN PARK CIR STE F
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City | BLUFFTON
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State | SC
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Zip | 29910-7023
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Country | US
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Telephone | 843-757-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 3220 HATCHET BAY DR APT 3325
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City | CHARLESTON
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State | SC
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Zip | 29414-5213
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Country | US
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Telephone | 828-242-3444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | PA4579
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License Number State | SC
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