Healthcare Provider Details

I. General information

NPI: 1699451179
Provider Name (Legal Business Name): LIBERTY FIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 COUNTY ROAD 427
AUBURN IN
46706-9504
US

IV. Provider business mailing address

5510 COUNTY ROAD 31
AUBURN IN
46706-9656
US

V. Phone/Fax

Practice location:
  • Phone: 833-338-6946
  • Fax:
Mailing address:
  • Phone: 260-570-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013472A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: