Provider Demographics
NPI:1508915554
Name:PREMOE, IUDOK (PNP)
Entity Type:Individual
Prefix:
First Name:IUDOK
Middle Name:
Last Name:PREMOE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 WEST PERIMETER ROAD
Mailing Address - Street 2:PEDIATRIC CLINIC
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:240-857-2723
Mailing Address - Fax:240-857-6263
Practice Address - Street 1:1050 W PERIMETER RD
Practice Address - Street 2:PEDIATRIC CLINIC
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-2723
Practice Address - Fax:240-857-6263
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114085363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics