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Individual
LARRY D LIEB
Active
Individual
LARRY D LIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA ARNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
D-059739
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5200063
CSA
IA
01
—
D-059739
CRNA LICENSE
IA
Enumeration date
04/27/2006
Last updated
03/07/2023
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