Provider Demographics
NPI:1396381307
Name:NIESE, AMY SUE (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:NIESE
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 1:1730 S REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1402
Mailing Address - Country:US
Mailing Address - Phone:419-893-5557
Mailing Address - Fax:419-893-5199
Practice Address - Street 1:1730 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1402
Practice Address - Country:US
Practice Address - Phone:419-893-5557
Practice Address - Fax:419-893-5199
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily