Provider Demographics
NPI:1154778496
Name:LIEBERKNECHT, WILLIAM (RN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:LIEBERKNECHT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19012 DOCKERY RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64084-9779
Mailing Address - Country:US
Mailing Address - Phone:816-536-5543
Mailing Address - Fax:
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015009100163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health