Individual
ALEXA HELENA NIEHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
2920 S MCINTIRE DR, SUITE 350, BLOOMINGTON, IN 47403-4221
(812) 353-3277
(812) 339-2934
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329
(812) 353-3087
(812) 353-5859
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001464A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540119
MEDICARE PTAN
IN
05
—
300009631
—
IN
Enumeration date
03/08/2007
Last updated
08/10/2023
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