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Individual
RANDALL SCOTT LIENEMANN
Active
Individual
RANDALL SCOTT LIENEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASST PA C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
638
NE
363AM0700X
Medical Physician Assistant
638
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00165113
RR MCR
—
Enumeration date
05/30/2006
Last updated
04/16/2018
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