Healthcare Provider Details

I. General information

NPI: 1396130050
Provider Name (Legal Business Name): RACHAEL LIEBMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 COMMERCIAL ST SE # NA
SALEM OR
97302-4204
US

IV. Provider business mailing address

1234 COMMERCIAL ST SE # NA
SALEM OR
97302-4204
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-4949
  • Fax: 503-585-4965
Mailing address:
  • Phone: 503-585-4949
  • Fax: 503-585-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95051770
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95051770
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201707000NP-PP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95007834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: