Provider Demographics
NPI:1558398958
Name:LIES, PATTY A (NP)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:A
Last Name:LIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:A
Other - Last Name:MARBACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4655
Mailing Address - Country:US
Mailing Address - Phone:701-642-2000
Mailing Address - Fax:701-671-4106
Practice Address - Street 1:275 11TH ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4655
Practice Address - Country:US
Practice Address - Phone:701-642-2000
Practice Address - Fax:701-671-4106
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR13793363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHP19529OtherHEALTHPARTNERS #
ND0408096OtherMEDICA #
ND680150OtherAMERICA'S PPO/ARAZ #
NDDA9051026978OtherPREFERRED ONE #
ND0407590OtherMEDICA #
ND29Q36LIOtherMNBS #
ND4724OtherNDBS #
ND00T74LIOtherMNBS #
ND3449OtherSIOUX VALLEY #
ND137048OtherUCARE #
ND19801Medicaid
ND26364OtherNDBS #
ND023H5LIOtherMNBS #
ND519515200Medicaid
ND3449OtherSIOUX VALLEY #
ND500001695Medicare ID - Type UnspecifiedRR MEDICARE #
ND00T74LIOtherMNBS #
ND0408096OtherMEDICA #
ND26364OtherNDBS #