Individual
HOLLY C LIBERATORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2310
(360) 414-2000
Mailing address
PO BOX 11510, WESTMINSTER, CA 92685-1510
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00042244
WA
207Q00000X
Family Medicine Physician
23705
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05483727
—
MS
05
—
8351926
—
WA
Enumeration date
07/06/2006
Last updated
05/27/2021
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