Doctor Name: | KATHERINE BIBB LIESEMER |
NPI Number: | 1952512683 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 58945 |
Business Practice Address: | Madigan Army Medical Ctr Bldg 9040 Fitzsimmons Dr Tacoma, WA - 984310001 |
Business Phone Number: | 2539685090 |
Business Fax Number: | |
Mailing Address: | Madigan Army Medical Ctr, Bldg 9040 Fitzsimmons Dr TACOMA |
State: | WA |
Postal Code: | 984310001 |
Phone Number: | 2539685090 |
Fax Number: | 2539681618 |
NPI Enumeration Date: | 05/24/2007 |
NPI Last Update Date: | 02/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 58945 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |