Individual
JOSEPH LIEBENROOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
35 ALBANY RD STE C, CARBONDALE, IL 62903-7647
(618) 457-5111
Mailing address
35 ALBANY RD STE C, CARBONDALE, IL 62903-7647
(618) 457-5111
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209007056
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2006023280
RN LICENSE
MO
Enumeration date
12/24/2007
Last updated
07/29/2010
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