Individual
ROBERT J NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
265 GRIFFIN ST. EAST, AMERY, WI 54001-1439
(715) 268-8000
(715) 268-0311
Mailing address
265 GRIFFIN ST. EAST, AMERY, WI 54001-1439
(715) 268-8000
(715) 268-0311
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10827
MN
363A00000X
Physician Assistant
2713-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639488406
—
MN
05
—
1639488406
—
WI
Enumeration date
09/28/2010
Last updated
06/27/2022
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