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General NPI Number Information
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NPI Number | 1093961898
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Entity Type | Individual
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Provider Name | JACQUELINE D LIESS APRN (NNP-BC)
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Gender | Female
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 10 E 31ST ST
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City | KEARNEY
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State | NE
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Zip | 68847-2926
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Country | US
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Telephone | 308-865-7139
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Fax |
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Provider Business Mailing Address
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Address Line | 4722 AVENUE E
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City | KEARNEY
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State | NE
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Zip | 68847-8305
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Country | US
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Telephone | 308-865-7139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 110954
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License Number State | NE
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