Liberty Nickelsberg, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN528329L Issued in PA

Practice address

5501 Old York Rd
Tower 3
Philadelphia, PA 19141-3018

Phone

(215) 456-3948

Fax

(215) 254-2599

NPI assigned

Dec 19, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Liberty Tambasacan Former name

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Einstein Practice Plan IncGroup PAC ID 2769395896, 774 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Einstein Philadelphia Hospital Hospital, Philadelphia, PA, CCN 390142

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Einstein Practice Plan Inc

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1760434468
  Medicare reassignment Care Compare group NPD
• North American Partners in Anesthesia, Pennsylvania , LLC

  • Anesthesiology Physician
  • Melville, NY
  • NPI 1639137854

  Nurse Anesthetist, Certified Registered, PA

  Medicare reassignment NPD
• Einstein Practice Plan Inc

  • Certified Registered Nurse Anesthetist
  • Philadelphia, PA
  • NPI 1457047433

  Nurse Anesthetist, Certified Registered

  NPD
• Einstein Practice Plan Inc

  • Anesthesiology Physician
  • Philadelphia, PA
  • NPI 1740232321
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Einstein Hospital

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1366653818
  Care Compare affiliation Name & address match

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361491200000",
    "number": "1700022845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E OLNEY AVE",
            "address_2": "SUITE 400",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191202421",
            "telephone_number": "215-456-7000",
            "fax_number": "215-254-2599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "address_2": "TOWER 3",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "215-456-3948",
            "fax_number": "215-254-2599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSBERG",
        "first_name": "LIBERTY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-19",
        "last_updated": "2013-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN528329L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA LICENSE",
            "identifier": "RN528329L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LIBERTY",
            "last_name": "TAMBASACAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caitlin Nicholson
• Danielle Nicholson, D.O.
• Denise M Nicholson
• John David Nicholson Jr., PA
• Keith Nicholson, D.D.S
• Jennifer Nickerson, CRNA
• Joshua Nickerson, DO
• Amanda Nickles
• Sean Michael Nickley, PH.D.
• David E Nicklin, MD

• Certified Registered Nurse Anesthetist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Certified Registered Nurse Anesthetist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.