1275741514 NPI number — MRS. SHERRY LYNN LIEBERZ P.T.A.

Table of content: MRS. SHERRY LYNN LIEBERZ P.T.A. (NPI 1275741514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275741514 NPI number — MRS. SHERRY LYNN LIEBERZ P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBERZ
Provider First Name:
SHERRY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275741514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
736 MABLE FRY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUKON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73099-2810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-354-8794
Provider Business Mailing Address Fax Number:
405-721-2025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6525 N MERIDIAN AVE STE 311
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-721-1115
Provider Business Practice Location Address Fax Number:
405-721-2025
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  693 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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