Provider Demographics
NPI:1477839892
Name:LIEBSCH, ANITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:LIEBSCH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BRIGHTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3625
Mailing Address - Country:US
Mailing Address - Phone:303-299-4528
Mailing Address - Fax:303-299-4556
Practice Address - Street 1:3801 BRIGHTON BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3625
Practice Address - Country:US
Practice Address - Phone:303-299-4528
Practice Address - Fax:303-299-4556
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO120915363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health