Provider Demographics
NPI:1578786083
Name:NIESLEY, MICHELLE LYNNE (ND)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE
Last Name:NIESLEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNNE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4175 E AMAZON DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4660
Mailing Address - Country:US
Mailing Address - Phone:541-338-9494
Mailing Address - Fax:541-338-8496
Practice Address - Street 1:4175 E AMAZON DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4660
Practice Address - Country:US
Practice Address - Phone:541-338-9494
Practice Address - Fax:541-338-8496
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1552175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath