Provider Demographics
NPI:1598148918
Name:NIEMEYER, RACHAEL (NP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-2168
Mailing Address - Country:US
Mailing Address - Phone:701-234-2119
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-5997
Practice Address - Fax:701-234-7194
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32530363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN721743Medicare PIN
NDN721744Medicare PIN