Individual
MS. ANNAWATI KOESDJOJO-LIEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
10 BROADWAY RD, PLATTSBURGH, NY 12901-1308
(518) 561-9711
(518) 561-9711
Mailing address
10 BROADWAY RD, PLATTSBURGH, NY 12901-1308
(518) 561-9711
(518) 561-9711
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
576297-1
NY
Other
Enumeration date
05/28/2009
Last updated
05/28/2009
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