Individual
KEVIN LIEBRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1515 N MADISON AVE, ANDERSON, IN 46011-3453
(317) 802-6302
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28154851
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200387980
—
IN
Enumeration date
11/16/2005
Last updated
12/08/2022
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