Individual
MARY J NIEMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3828 KENTUCKY LN, HUDSONVILLE, MI 49426-8107
(616) 340-4633
Mailing address
3828 KENTUCKY LANE, HUDSONVILLE, MI 49426-0000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704190536
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4831608
—
MI
01
—
MN190536
BLUE CROSS BLUE SHIELD
—
01
—
P00321466
RAILROAD MEDICARE
MI
Enumeration date
12/30/2005
Last updated
05/09/2014
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