Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Douglas Jason Lieberman

Individual provider Nurse Practitioner · NPI 1942780382

Douglas Jason Lieberman is a Nurse Practitioner in Las Vegas, Nevada. Qualified in 2017, 9 years ago. Practices with Impact Health PC, a 79-clinician group and works from 2 locations. Licensed in Connecticut, Idaho and Nevada.

Years since qualifying
9
Licensed in
CT, ID, NV
In the registry since
2018
Specialties on file
3
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Practice location Address checks out

5523 S Eastern Ave
Las Vegas, NV 89119-2312
Phone: (702) 463-4050
Fax: (702) 463-7881
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 61 Bellevue Ave, Bristol, CT 06010-5815 — (860) 589-1682

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 812736 (NV)
Nurse Practitioner Taxonomy 363L00000X · Licence 57640 (ID)
Nurse Practitioner Taxonomy 363L00000X · Licence 008028 (CT)

Record details

NPI number1942780382
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 15, 2018
Last updated in NPPESFebruary 1, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Impact Health Pc — 79 clinicians
Accepts Medicare assignment Not indicated

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