| NPI | 1972836385 |
|---|---|
| Former Name | KELLY MARIE LIEDBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R29405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN R156241-1) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2019-02-28 |