Healthcare Provider Details

I. General information

NPI: 1952849838
Provider Name (Legal Business Name): SUSAN P LIEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN P PARKER

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST SUITE 6100
KANSAS CITY MO
64111-5961
US

IV. Provider business mailing address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-2707
  • Fax: 816-932-1383
Mailing address:
  • Phone: 816-502-8752
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number124985
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: