Provider Demographics
NPI:1821609488
Name:LEGIERSE, JULIANNE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:LEGIERSE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:CLEMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:10 MISSILE AVE
Mailing Address - Street 2:
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58705-5003
Mailing Address - Country:US
Mailing Address - Phone:701-723-5663
Mailing Address - Fax:
Practice Address - Street 1:10 MISSLE AVE 5TH MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:MINOT AFB
Practice Address - State:ND
Practice Address - Zip Code:58405-2040
Practice Address - Country:US
Practice Address - Phone:701-723-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179913363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics