Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2011026365 | MO |
NPI | 1346511698 |
---|---|
Provider Name | Jennifer Nieman |
First Address | Shawnee, KS 66226-7504 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |