Healthcare Provider Details

I. General information

NPI: 1699803932
Provider Name (Legal Business Name): LINDA STAUFF LIEBERMAN CNM, MSN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 NW BUCHANAN AVE STE 7
CORVALLIS OR
97330-6217
US

IV. Provider business mailing address

3080 NW AUTUMN ST
CORVALLIS OR
97330-3802
US

V. Phone/Fax

Practice location:
  • Phone: 541-753-6000
  • Fax: 541-753-6001
Mailing address:
  • Phone: 541-753-6000
  • Fax: 541-753-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number088000249RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0088000249N5 NMNP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0088000249N5 NMNP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number088000249N5
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number088000249N5
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: