Individual
MS. AGNES LIEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC, AE-C
Contact information
Practice address
10 MISSILE AVE, MINOT AFB, ND 58705-5003
(701) 723-5138
(609) 754-9195
Mailing address
194 MISSILE AVE, MINOT AFB, ND 58701
(701) 723-5138
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
026.0042618
VT
163W00000X
Registered Nurse
601494-1
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
F382111-1
NY
363LP0200X
Pediatric Nurse Practitioner
R43064
ND
Other
Enumeration date
07/29/2009
Last updated
04/28/2016
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