Provider Demographics
NPI:1720183247
Name:NIEMEIER, GINA R (PA-C)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:R
Last Name:NIEMEIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:R
Other - Last Name:TOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6700
Mailing Address - Fax:812-450-6710
Practice Address - Street 1:520 MARY ST
Practice Address - Street 2:SUITE 340
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1677
Practice Address - Country:US
Practice Address - Phone:812-450-6700
Practice Address - Fax:812-450-6710
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000344A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN257900004Medicare PIN