Individual
KEVIN HAL LILJENQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
444 FOUR STATES DR STE 2, GALENA, KS 66739-4325
(620) 783-4000
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2017026396
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
2022021647
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910110875
—
MO
Enumeration date
03/30/2022
Last updated
06/12/2023
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