Provider Demographics
NPI:1306622816
Name:LIBERT, THERESA ANN (RNFA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:LIBERT
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFA
Mailing Address - Street 1:2620 SPINNAKER DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-5752
Mailing Address - Country:US
Mailing Address - Phone:775-530-5040
Mailing Address - Fax:
Practice Address - Street 1:6630 S MCCARRAN BLVD STE C25
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6187
Practice Address - Country:US
Practice Address - Phone:775-827-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15645163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant