Provider Demographics
NPI:1699803932
Name:LIEBERMAN, LINDA STAUFF (CNM, MSN, NP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:STAUFF
Last Name:LIEBERMAN
Suffix:
Gender:F
Credentials:CNM, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 NW AUTUMN ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3802
Mailing Address - Country:US
Mailing Address - Phone:541-753-6000
Mailing Address - Fax:541-753-6001
Practice Address - Street 1:833 NW BUCHANAN AVE STE 7
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6217
Practice Address - Country:US
Practice Address - Phone:541-753-6000
Practice Address - Fax:541-753-6001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088000249RN163W00000X
OR0088000249N5 NMNP-PP363L00000X, 367A00000X
OR088000249N5363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20377OtherPACIFICSOURCE
OR009364000OtherREGENCE BCBS OF OREGON
OR276641Medicaid
S86665Medicare UPIN
104826Medicare ID - Type Unspecified