Provider Demographics
NPI:1568199115
Name:LIBERTY, APRIL ANNE (AG-CNS)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:ANNE
Last Name:LIBERTY
Suffix:
Gender:F
Credentials:AG-CNS
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:ANNE
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 HIGHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-2578
Mailing Address - Country:US
Mailing Address - Phone:586-855-9370
Mailing Address - Fax:
Practice Address - Street 1:230 HIGHGATE AVE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-2578
Practice Address - Country:US
Practice Address - Phone:586-855-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300110364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontologyGroup - Single Specialty