Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 201922 | NC |
NPI | 1518178003 |
---|---|
Provider Name | Ms. Grace Liem |
First Address | Concord, NC 28025-4300 |
Second Address | Concord, NC 28025-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 16/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7005175 | (05) | NC |