Healthcare Provider Details

I. General information

NPI: 1588705552
Provider Name (Legal Business Name): REBECCA A LIEBERT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W SAHARA AVE STE 800
LAS VEGAS NV
89102-4397
US

IV. Provider business mailing address

501 GOPHER DR
TOMAH WI
54660-4513
US

V. Phone/Fax

Practice location:
  • Phone: 203-666-8145
  • Fax:
Mailing address:
  • Phone: 608-372-2181
  • Fax: 608-374-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2751
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number829613
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: