| Doctor Name: | IUDOK PREMOE |
| NPI Number: | 1508915554 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PNP |
| License Number: | R114085 |
| Business Practice Address: | 1050 W Perimeter Rd Pediatric Clinic Andrews Afb, MD - 207626601 |
| Business Phone Number: | 2408572723 |
| Business Fax Number: | 2408576263 |
| Mailing Address: | 1058 West Perimeter Road, Pediatric Clinic ANDREWS AFB |
| State: | MD |
| Postal Code: | 20762 |
| Phone Number: | 2408572723 |
| Fax Number: | 2408576263 |
| NPI Enumeration Date: | 01/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | R114085 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |