Provider Demographics
NPI:1063880300
Name:NIERMAN, KENNETH ALLEN (BS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ALLEN
Last Name:NIERMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6871 XAVIER CIR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-5774
Mailing Address - Country:US
Mailing Address - Phone:720-334-7115
Mailing Address - Fax:
Practice Address - Street 1:6871 XAVIER CIR UNIT 2
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-5774
Practice Address - Country:US
Practice Address - Phone:720-334-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other