Healthcare Provider Details

I. General information

NPI: 1841744646
Provider Name (Legal Business Name): WILLIAM LIEBBE APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 17TH ST
ROCK ISLAND IL
61201-5351
US

IV. Provider business mailing address

20820 257TH AVE
LE CLAIRE IA
52753-9708
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-2301
  • Fax:
Mailing address:
  • Phone: 563-320-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG131315
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.016894
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: