Provider Demographics
NPI:1922840859
Name:LIEBLER, JAMIE LYNN (CDN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:LIEBLER
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 GOUNDRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-6113
Mailing Address - Country:US
Mailing Address - Phone:716-536-1546
Mailing Address - Fax:
Practice Address - Street 1:511 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5779
Practice Address - Country:US
Practice Address - Phone:716-815-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011128-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered