Provider Demographics
NPI:1578327631
Name:NIESEN, LORI ANN (CD(DONA))
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:NIESEN
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 PARKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2603
Mailing Address - Country:US
Mailing Address - Phone:612-816-7984
Mailing Address - Fax:
Practice Address - Street 1:9401 PARKSIDE CIR
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2603
Practice Address - Country:US
Practice Address - Phone:612-816-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13465374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula