Healthcare Provider Details

I. General information

NPI: 1952382244
Provider Name (Legal Business Name): MAUREEN K LIEFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MAUREEN K CASETTA RN

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6172 RICHFIELD RD
RED BUD IL
62278-4632
US

IV. Provider business mailing address

6172 RICHFIELD RD
RED BUD IL
62278-4632
US

V. Phone/Fax

Practice location:
  • Phone: 618-282-2072
  • Fax:
Mailing address:
  • Phone: 618-282-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number070157
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: