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General NPI Number Information
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NPI Number | 1588224059
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Entity Type | Individual
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Provider Name | GINA MARIE LIEBL APRN-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 1017 JACKSON ST STE C
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City | GREAT BEND
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State | KS
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Zip | 67530-4200
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Country | US
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Telephone | 620-792-3666
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Fax | 360-790-3667
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Provider Business Mailing Address
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Address Line | 9300 E 29TH ST N STE 310
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City | WICHITA
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State | KS
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Zip | 67226-2160
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Country | US
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Telephone | 316-612-1833
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Fax | 316-612-2420
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 78773
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License Number State | KS
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