Provider Demographics
NPI:1417196395
Name:NIEVIEROWSKI, SHAWNA IRENE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:IRENE
Last Name:NIEVIEROWSKI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-907-7636
Mailing Address - Fax:989-907-7584
Practice Address - Street 1:1015 S WASHINGTON AVE STE E
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-907-7636
Practice Address - Fax:989-907-7584
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230670363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417196395Medicaid
MI1417196395Medicaid