Provider Demographics
NPI:1508270927
Name:NIEMEYER-METLING, SHANNEN R (APRN CNP)
Entity type:Individual
Prefix:MS
First Name:SHANNEN
Middle Name:R
Last Name:NIEMEYER-METLING
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:SHANNEN
Other - Middle Name:R
Other - Last Name:NIEMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN CNP
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 173601-4363L00000X
MN2653363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner