Provider Demographics
NPI:1881660280
Name:LIBERATORE, KATHY JOHANNA (RN, MN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JOHANNA
Last Name:LIBERATORE
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Gender:F
Credentials:RN, MN, CNS
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Mailing Address - Street 1:800 RALSTON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BLACK HAWK
Mailing Address - State:CO
Mailing Address - Zip Code:80422-8842
Mailing Address - Country:US
Mailing Address - Phone:303-582-5292
Mailing Address - Fax:
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:CARDILOGY 111-B
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3808
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:303-393-5054
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2010-01-18
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Provider Licenses
StateLicense IDTaxonomies
CO51776364S00000X
CO0672364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist