Healthcare Provider Details

I. General information

NPI: 1831179613
Provider Name (Legal Business Name): CONNIE JO LIERMAN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CHAMPLAIN ST NW
WASHINGTON DC
20009-2618
US

IV. Provider business mailing address

6301 MOUNTAIN BRANCH CT
BETHESDA MD
20817-5838
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-9022
  • Fax: 202-232-8494
Mailing address:
  • Phone: 202-232-9022
  • Fax: 202-232-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN31274
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: