Iudok Premoe, PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Andrews Afb, MD
NPI 1508915554 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508915554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- R114085 (MD)
- Practice address
- 1050 W Perimeter Rd
Pediatric Clinic
Andrews Afb, MD 20762-6601 - Phone
- (240) 857-2723
- Fax
- (240) 857-6263
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R114085 | MD | MD | Pediatric Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R114085 | MD | Yes |
Addresses
Primary practice location
1050 W Perimeter Rd
Pediatric Clinic
Andrews Afb, MD 20762-6601
Mailing address
1058 West Perimeter Road
Pediatric Clinic
Andrews Afb, MD 20762
Phone (240) 857-2723
Other providers in Andrews Afb, MD
- National Vision, Inc.
- Thomas Augustine Neal II
- Jayasree Patla
- Johnathan A Paxton
- Angela Patrice Pettis
- John C. Pritchett
- Gregory Thomas Rehe
- Christopher Clement Rhoney
- Brandi Alyssa Ritter
- Dexter Dewayne Robinson
All providers in Andrews Afb, MD · Pediatric Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.