Provider Demographics
NPI:1669610812
Name:LIEBEN, KATRINA R (CNM, RN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:R
Last Name:LIEBEN
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAWS AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6540
Mailing Address - Country:US
Mailing Address - Phone:707-468-1010
Mailing Address - Fax:
Practice Address - Street 1:333 LAWS AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6540
Practice Address - Country:US
Practice Address - Phone:707-468-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1973367A00000X
AK18935 AND 1065367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife