Individual
MARIVI A NIEBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, SUITE 312, ABINGDON, VA 24211-7664
(276) 258-3733
(276) 258-3734
Mailing address
16000 JOHNSTON MEMORIAL DR, SUITE 312, ABINGDON, VA 24211-7664
(276) 258-3733
(276) 258-3734
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
0101249956
VA
2084N0400X
Neurology Physician
39937
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275521239
—
VA
05
—
3334027
—
TN
01
—
P01200682
RAILROAD MEDICARE
VA
Enumeration date
10/12/2005
Last updated
02/21/2017
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