Healthcare Provider Details

I. General information

NPI: 1073406450
Provider Name (Legal Business Name): HEIDI LIBENGOOD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S MILL ST
NEW CASTLE PA
16101-4629
US

IV. Provider business mailing address

63 PITT ST
SHARON PA
16146-2102
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-4564
  • Fax: 724-657-8563
Mailing address:
  • Phone: 724-658-4563
  • Fax: 724-657-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP032686
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: