Individual
MR. MICHAEL ROBERT NIERAETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8854 W EMERALD ST STE 102, BOISE, ID 83704
(208) 323-4747
(208) 323-4848
Mailing address
8854 W EMERALD ST STE 102, BOISE, ID 83704-4845
(208) 323-4747
(208) 323-4848
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-993
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487904280
—
ID
Enumeration date
09/19/2012
Last updated
03/25/2019
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