Healthcare Provider Details

I. General information

NPI: 1932861366
Provider Name (Legal Business Name): GERALDINE LIBAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3735 ARIZONA 95
BULLHEAD CITY AZ
86442-5388
US

IV. Provider business mailing address

3735 ARIZONA 95
BULLHEAD CITY AZ
86442
US

V. Phone/Fax

Practice location:
  • Phone: 928-444-1444
  • Fax:
Mailing address:
  • Phone: 928-444-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100459
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number270797
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN211377
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: