Provider Demographics
NPI:1245561984
Name:LIEBMAN, VICTORIA MICHELE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:MICHELE
Last Name:LIEBMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MICHELE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12650 W 64TH AVE
Mailing Address - Street 2:UNIT E501
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-3893
Mailing Address - Country:US
Mailing Address - Phone:303-979-7200
Mailing Address - Fax:303-933-5265
Practice Address - Street 1:7335 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4571
Practice Address - Country:US
Practice Address - Phone:303-979-7200
Practice Address - Fax:303-933-5265
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant