Provider Demographics
NPI:1356674675
Name:SOROSIAK, LIBBY A (NP)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:A
Last Name:SOROSIAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30000 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3429
Mailing Address - Country:US
Mailing Address - Phone:419-661-4001
Mailing Address - Fax:
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N STE 425
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2340
Practice Address - Country:US
Practice Address - Phone:419-356-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN267190363L00000X
OHCOA-10850-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner