Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 360000659A | IN |
Y | 213ES0000X | Sports Medicine | 360000659A | IN |
NPI | 1245636380 |
---|---|
Provider Name | Malinda Nieman |
First Address | Crown Point, IN 46307-9148 |
Second Address | Crown Point, IN 46307-8693 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2014 |
Last Update Date | 18/11/2014 |