Healthcare Provider Details

I. General information

NPI: 1871300780
Provider Name (Legal Business Name): MEGAN MARY LIEBMANN FNLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37601 E KNIERIEM RD
CORBETT OR
97019-8818
US

IV. Provider business mailing address

37601 E KNIERIEM RD
CORBETT OR
97019-8818
US

V. Phone/Fax

Practice location:
  • Phone: 503-970-6043
  • Fax:
Mailing address:
  • Phone: 503-970-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: