Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP8087 | AZ |
NPI | 1013354489 |
---|---|
Provider Name | Nicholas Niemyer |
First Address | Phoenix, AZ 85012-1334 |
Second Address | Queen Creek, AZ 85140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2013 |
Last Update Date | 24/04/2019 |