Individual
DR. JONATHAN LIBBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP, APRN, CPNP
Contact information
Practice address
100 CAMPUS AVE APT 203, LEWISTON, ME 04240-6079
(207) 755-3160
(207) 755-3166
Mailing address
PO BOX 10187, ALBANY, NY 12201-5187
(207) 777-4111
(207) 783-6660
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
041889
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245420099
—
ME
Enumeration date
04/10/2006
Last updated
06/03/2015
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