| NPI | 1841584844 |
|---|---|
| Former Name | HAVILAH LIEDERBACH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 201407546NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201500894NP-PP) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2019-08-15 |