Provider Demographics
NPI:1083319115
Name:NIEMAN, KATELYN (NP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 S 102ND ST STE 160
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2142
Mailing Address - Country:US
Mailing Address - Phone:414-255-0340
Mailing Address - Fax:855-342-0199
Practice Address - Street 1:2514 S 102ND ST STE 160
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2142
Practice Address - Country:US
Practice Address - Phone:414-255-0340
Practice Address - Fax:855-342-0199
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13642-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology