Basic Information
Provider Information
NPI: 1386639748
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIBBY
FirstName: ARLENE
MiddleName: L.
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5802 WRIGHT DR
Address2:  
City: LOVELAND
State: CO
PostalCode: 805388806
CountryCode: US
TelephoneNumber: 9702120530
FaxNumber:  
Practice Location
Address1: 5802 WRIGHT DR
Address2:  
City: LOVELAND
State: CO
PostalCode: 805388806
CountryCode: US
TelephoneNumber: 9706354126
FaxNumber: 9702032509
Other Information
ProviderEnumerationDate: 09/13/2005
LastUpdateDate: 05/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X8416AWYN Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
207ZP0102X39358COY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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