Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 50.005850RX | OH |
NPI | 1013472109 |
---|---|
Provider Name | Ms. Shayna Leigh Niese |
First Address | Elida, OH 45807-1989 |
Second Address | Grove City, OH 43123-2546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 04/02/2019 |