Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 110954 | NE |
NPI | 1093961898 |
---|---|
Provider Name | Mrs. Jacqueline D Liess |
First Address | Kearney, NE 68847-8305 |
Second Address | Kearney, NE 68847-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 12/08/2008 |