Provider Demographics
NPI:1346959574
Name:NIEMEYER, AMBER ROSE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 OLD HICKORY BLVD UNIT 62
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3952
Mailing Address - Country:US
Mailing Address - Phone:920-979-0997
Mailing Address - Fax:
Practice Address - Street 1:641 OLD HICKORY BLVD UNIT 62
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3952
Practice Address - Country:US
Practice Address - Phone:920-979-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000005146363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant