Provider Demographics
NPI:1063500247
Name:KENNEDY LALIBERTE, ELIZABETH MAUREEN (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAUREEN
Last Name:KENNEDY LALIBERTE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1601 SAINT FRANCIS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3384
Mailing Address - Country:US
Mailing Address - Phone:952-403-3535
Mailing Address - Fax:950-403-3599
Practice Address - Street 1:1601 SAINT FRANCIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3384
Practice Address - Country:US
Practice Address - Phone:952-403-3535
Practice Address - Fax:950-403-3599
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10163363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical