Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704330088NSA210G9 | MI |
NPI | 1003485194 |
---|---|
Provider Name | Ms. Marissa Claire Niemeyer |
First Address | San Antonio, TX 78216-4664 |
Second Address | San Antonio, TX 78216-4664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 27/09/2021 |