Provider Demographics
NPI:1194448027
Name:LIEBICH, CAITLYN (FNP-C)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:LIEBICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PRAIRIE ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5715
Mailing Address - Country:US
Mailing Address - Phone:419-290-5865
Mailing Address - Fax:
Practice Address - Street 1:5700 MONROE ST UNIT 310
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2768
Practice Address - Country:US
Practice Address - Phone:419-578-7555
Practice Address - Fax:419-539-6336
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily