Provider Demographics
NPI:1871300780
Name:LIEBMANN, MEGAN MARY (FNLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARY
Last Name:LIEBMANN
Suffix:
Gender:F
Credentials:FNLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37601 E KNIERIEM RD
Mailing Address - Street 2:
Mailing Address - City:CORBETT
Mailing Address - State:OR
Mailing Address - Zip Code:97019-8818
Mailing Address - Country:US
Mailing Address - Phone:503-970-6043
Mailing Address - Fax:
Practice Address - Street 1:37601 E KNIERIEM RD
Practice Address - Street 2:
Practice Address - City:CORBETT
Practice Address - State:OR
Practice Address - Zip Code:97019-8818
Practice Address - Country:US
Practice Address - Phone:503-970-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty