Individual
MR. WILLIAM HENRY NIEMEYER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
385 W MAIN ST, AVON, CT 06001-4357
(860) 777-1280
Mailing address
1832 ASHLEY DRIVE, CHARLESTON, IL 61920
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
004173
CT
363A00000X
Physician Assistant
Primary
085-001528
IL
363A00000X
Physician Assistant
PA01134
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004173
CT LIC
CT
Enumeration date
06/13/2006
Last updated
09/21/2020
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