Healthcare Provider Details

I. General information

NPI: 1669556379
Provider Name (Legal Business Name): CARLYN M LIEBERT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22707 SE 29TH ST
SAMMAMISH WA
98075-9532
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-2845
  • Fax: 425-861-8602
Mailing address:
  • Phone: 425-455-2845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP3000651
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: