Provider Demographics
NPI:1487734364
Name:NIEMEYER, KATHRYN JEAN (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JEAN
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ATKINSON DRIVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:231-843-3600
Mailing Address - Fax:231-845-9887
Practice Address - Street 1:5 ATKINSON DRIVE
Practice Address - Street 2:SUITE #207
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431
Practice Address - Country:US
Practice Address - Phone:231-843-3600
Practice Address - Fax:231-845-9887
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5008703470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDC1085OtherRAILROAD MEDICARE
MI5008703470OtherBC BS
Q24567Medicare UPIN
MI0N99190Medicare ID - Type Unspecified