Healthcare Provider Details

I. General information

NPI: 1881660280
Provider Name (Legal Business Name): KATHY JOHANNA LIBERATORE RN, MN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST CARDILOGY 111-B
DENVER CO
80220-3808
US

IV. Provider business mailing address

800 RALSTON CREEK LN
BLACK HAWK CO
80422-8842
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax: 303-393-5054
Mailing address:
  • Phone: 303-582-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number51776
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0672
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: