Provider Demographics
NPI:1912250242
Name:LIEBERMAN, BRENDALYNN IJEOMA-IBE (NP)
Entity type:Individual
Prefix:MRS
First Name:BRENDALYNN
Middle Name:IJEOMA-IBE
Last Name:LIEBERMAN
Suffix:
Gender:
Credentials:NP
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Mailing Address - Street 1:10850 PROVIDENCE RD STE 1260
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2684
Mailing Address - Country:US
Mailing Address - Phone:248-766-5786
Mailing Address - Fax:
Practice Address - Street 1:10850 PROVIDENCE RD STE 1260
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2684
Practice Address - Country:US
Practice Address - Phone:248-766-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5012382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704249739OtherLICENSE NUMBER