Provider Demographics
NPI:1134498165
Name:JOHN R. NIENOW, M.D., INC
Entity Type:Organization
Organization Name:JOHN R. NIENOW, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NIENOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-679-3693
Mailing Address - Street 1:500 UNIVERSITY AVE
Mailing Address - Street 2:200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6504
Mailing Address - Country:US
Mailing Address - Phone:916-679-3693
Mailing Address - Fax:916-679-3699
Practice Address - Street 1:500 UNIVERSITY AVE
Practice Address - Street 2:200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6504
Practice Address - Country:US
Practice Address - Phone:916-679-3693
Practice Address - Fax:916-679-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty