Provider Demographics
NPI:1699005777
Name:NIECKO, DIANNE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:MARIE
Last Name:NIECKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E MICHIGAN AVE
Mailing Address - Street 2:STE A100
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-4005
Mailing Address - Country:US
Mailing Address - Phone:269-965-3539
Mailing Address - Fax:269-966-1489
Practice Address - Street 1:190 E MICHIGAN AVE
Practice Address - Street 2:STE A100
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-4005
Practice Address - Country:US
Practice Address - Phone:269-965-3539
Practice Address - Fax:269-966-1489
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704109999363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health