Provider Demographics
NPI:1093480113
Name:NIEHUSS, MICHAEL T (CRNP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:NIEHUSS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:8720 FAIRHOPE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3608
Mailing Address - Country:US
Mailing Address - Phone:251-990-2441
Mailing Address - Fax:251-990-2242
Practice Address - Street 1:8720 FAIRHOPE AVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3608
Practice Address - Country:US
Practice Address - Phone:251-990-2441
Practice Address - Fax:251-990-2242
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1-105485208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology