Provider Demographics
NPI:1316708787
Name:LIBURD, COLLEEN (RN)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:LIBURD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8062
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-8062
Mailing Address - Country:US
Mailing Address - Phone:340-277-3853
Mailing Address - Fax:
Practice Address - Street 1:4031 LA GRANDE PRINCESS SUITE 34
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-473-9502
Practice Address - Fax:678-926-3972
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI9224163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1225567597Medicaid
GA1225567597OtherCIGNA HEALTH CARE