Healthcare Provider Details

I. General information

NPI: 1477839892
Provider Name (Legal Business Name): ANITA LIEBSCH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BRIGHTON BLVD
DENVER CO
80216-3625
US

IV. Provider business mailing address

3801 BRIGHTON BLVD
DENVER CO
80216-3625
US

V. Phone/Fax

Practice location:
  • Phone: 303-299-4528
  • Fax: 303-299-4556
Mailing address:
  • Phone: 303-299-4528
  • Fax: 303-299-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number120915
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: