Provider Demographics
NPI:1568179513
Name:LIEBING, KATHRYN WALLER (CNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:WALLER
Last Name:LIEBING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:CHRISTINE
Other - Last Name:WALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10506A MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-246-2343
Mailing Address - Fax:513-246-4047
Practice Address - Street 1:10506A MONTGOMERY ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-246-2343
Practice Address - Fax:513-246-4047
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32767363LA2100X
OHAPRN.CNP.0037558363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care