=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942336540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHY JO LEIBY R.N., C.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4230 CRUMS MILL RD SUITE 201
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17112-2898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-828-7711
-----------------------------------------------------
Fax | 717-657-9088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 FRANKLIN RD
-----------------------------------------------------
City | BECHTELSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19505-9246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-369-0680
-----------------------------------------------------
Fax | 610-369-3657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246W00000X
-----------------------------------------------------
Taxonomy Name | Cardiology Technician
-----------------------------------------------------
License Number | RN200256L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------