Provider Demographics
NPI:1851794820
Name:LIBERTY, RICHARD (FNPBC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:LIBERTY
Suffix:
Gender:M
Credentials:FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 CUSHING RD
Mailing Address - Street 2:C/O MEDICAL DEPT.
Mailing Address - City:WARREN
Mailing Address - State:ME
Mailing Address - Zip Code:04864-4603
Mailing Address - Country:US
Mailing Address - Phone:207-273-5485
Mailing Address - Fax:207-273-5465
Practice Address - Street 1:807 CUSHING RD
Practice Address - Street 2:C/O MEDICAL DEPT.
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4603
Practice Address - Country:US
Practice Address - Phone:207-273-5485
Practice Address - Fax:207-273-5465
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily