Individual
TODD L MCNIESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
2500 E CAPITOL DR STE 1200, APPLETON, WI 54911-8735
(920) 830-6877
(999) 999-9999
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 454-4101
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5007
WI
Other
Enumeration date
03/01/2012
Last updated
06/18/2020
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