Provider Demographics
NPI:1609492107
Name:NIEMELA, KATHERINE (RN, MN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:NIEMELA
Suffix:
Gender:F
Credentials:RN, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 PRIMROSE AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2899
Mailing Address - Country:US
Mailing Address - Phone:310-880-4737
Mailing Address - Fax:
Practice Address - Street 1:5619 W 4TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:310-880-4737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN386956163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent