Provider Demographics
NPI:1790266518
Name:COLSEN, LIBBY SARAH (CPM)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:SARAH
Last Name:COLSEN
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 SEVIERVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6519
Mailing Address - Country:US
Mailing Address - Phone:865-456-4147
Mailing Address - Fax:
Practice Address - Street 1:4873 CHAMBLISS AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5122
Practice Address - Country:US
Practice Address - Phone:865-456-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18050009176B00000X
TN77176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife