Individual provider · Type 1 NPI
Agnes Liem, CPNP-PC, AE-C
Pediatric Nurse Practitioner · Minot Afb, ND
NPI number
1508097247
Active
Practice location
10 Missile Ave
Minot Afb, ND 58705-5003
Fax (609) 754-9195
Mailing address
194 Missile Ave
Minot Afb, ND 58701
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 601494-1 (NY) |
| Registered Nurse | 163W00000X | 026.0042618 (VT) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | F382111-1 (NY) |
| Pediatric Nurse Practitioner | 363LP0200X | R43064 (ND) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1508097247
Agnes Liem, CPNP-PC, AE-C's National Provider Identifier is 1508097247, issued on Jul 29, 2009. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Minot Afb, ND. The record was last updated on Apr 28, 2016.