Healthcare Provider Details

I. General information

NPI: 1659763399
Provider Name (Legal Business Name): ANDREA LIEBER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 S TRUMBULL ST
BAY CITY MI
48708-4217
US

IV. Provider business mailing address

714 S TRUMBULL ST
BAY CITY MI
48708-4217
US

V. Phone/Fax

Practice location:
  • Phone: 989-893-5541
  • Fax:
Mailing address:
  • Phone: 989-893-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704276168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: