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NPI Code Detail

MEDICARE: JULIE ANNE LIBERTY AGPCNP-BC

MEDICARE: JULIE ANNE LIBERTY AGPCNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner2026024314MI
2163W00000XRegistered Nurse4704370532MI

General Provider Information

NPI Number : 1639038458
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE ANNE LIBERTY AGPCNP-BC
Provider Business Mailing Address
First Line : 10230 SMITHS CREEK RD
Second Line :
City : WALES
State : MI
Zip : 48027-3409
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-916-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 05/26/2026

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Directions to “ JULIE ANNE LIBERTY AGPCNP-BC” Practice Location

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