NPI 1508097247 · live from the CMS NPI Registry
Agnes Liem, CPNP-PC, AE-C
Nurse Practitioner, Pediatrics in Minot Afb, ND. National Provider Identifier 1508097247, active.
NPI record
| NPI | 1508097247 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 10 Missile Ave, Minot Afb, ND 58705 |
| Practice phone | 701-723-5138 |
| Mailing address | 194 Missile Ave, Minot Afb, ND 58701 |
| Enumerated | July 29, 2009 |
| Last updated | April 28, 2016 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 601494-1 (NY) |
| Registered Nurse | 163W00000X | 026.0042618 (VT) |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | F382111-1 (NY) |
| Nurse Practitioner, Pediatrics | 363LP0200X | R43064 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.