Provider Demographics
NPI:1356631592
Name:NIEMEYER, JUDITH DIANE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:DIANE
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12241 STALLMAN RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5257
Mailing Address - Country:US
Mailing Address - Phone:218-829-9655
Mailing Address - Fax:218-829-9655
Practice Address - Street 1:7830 149TH LN NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-4342
Practice Address - Country:US
Practice Address - Phone:763-422-9713
Practice Address - Fax:763-421-3098
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 80435-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse