Active NPI
Larry D Lieb, CRNA ARNP
- Nurse Practitioner
- Lake City, IA
National Provider Identifier
1972560779
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- D-059739
- Practice address
- 1301 W Main St
Lake City, IA 51449-1585 - Phone
- (712) 464-3171
- Fax
- (712) 464-7412
- NPI assigned
- Apr 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | D-059739 | IA | Primary |
Addresses
Primary practice location
1301 W Main St
Lake City, IA 51449-1585
Mailing address
225 W Randall Rd
Carroll, IA 51401-3601
Phone (712) 792-1004
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5200063 | Other | IA | CSA |
| D-059739 | Other | IA | CRNA LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-059739 | IA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1972560779",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 W RANDALL RD",
"city": "CARROLL",
"state": "IA",
"postal_code": "514013601",
"telephone_number": "712-792-1004",
"fax_number": "712-792-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 W MAIN ST",
"city": "LAKE CITY",
"state": "IA",
"postal_code": "514491585",
"telephone_number": "712-464-3171",
"fax_number": "712-464-7412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEB",
"first_name": "LARRY",
"middle_name": "D",
"credential": "CRNA ARNP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IA",
"license": "D-059739",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CSA",
"identifier": "5200063",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRNA LICENSE",
"identifier": "D-059739",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.