Provider Demographics
NPI:1043309578
Name:LIEBE, DIANE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LIEBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-865-6175
Mailing Address - Fax:
Practice Address - Street 1:3801 KERN WAY
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6340
Practice Address - Country:US
Practice Address - Phone:509-574-3220
Practice Address - Fax:509-574-3211
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028459208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8127755OtherCHPW
WA61688OtherL & I
911019392OtherCOMMERCIAL
WALI2892OtherREGENCE
22850OtherGROUP HEALTH
WA8127755Medicaid
WALI2892OtherREGENCE