Individual
MATTHEW STEVEN NIENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
715 S TAFT AVE, FREMONT, OH 43420-3237
(419) 334-6639
(419) 333-2793
Mailing address
715 S TAFT AVE, FREMONT, OH 43420-3237
(419) 334-6661
(419) 334-6685
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.002810
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0071619
—
OH
Enumeration date
09/12/2008
Last updated
11/22/2019
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