Basic Information
Provider Information
NPI: 1104564871
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIBER
FirstName: CHRISTINA
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11018 S THERESA CIR APT 3A
Address2:  
City: PALOS HILLS
State: IL
PostalCode: 604652285
CountryCode: US
TelephoneNumber: 7082372145
FaxNumber:  
Practice Location
Address1: 1755 PARK ST STE 100
Address2:  
City: NAPERVILLE
State: IL
PostalCode: 605638477
CountryCode: US
TelephoneNumber: 8774864140
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/23/2022
LastUpdateDate: 07/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  N    
106S00000XRBT-22-226523ILY    

No ID Information.


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