Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 209007551 | IL |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 199137795 | MO |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 209007551 | IL |
NPI | 1245351774 |
---|---|
Provider Name | Mrs. Randi L Niemeyer |
First Address | Swansea, IL 62226-8922 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 13/11/2019 |