Provider Demographics
NPI:1154879757
Name:LIEBENSTEIN, KATELYN (CNP, FNP-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:LIEBENSTEIN
Suffix:
Gender:F
Credentials:CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 HARKLE RD
Mailing Address - Street 2:STE E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4765
Mailing Address - Country:US
Mailing Address - Phone:505-989-8200
Mailing Address - Fax:505-989-8131
Practice Address - Street 1:649 HARKLE RD STE E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4765
Practice Address - Country:US
Practice Address - Phone:505-989-8200
Practice Address - Fax:505-216-9067
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily