Provider Demographics
NPI:1740005610
Name:MOMMER, NIKIAH LILLIAN
Entity type:Individual
Prefix:
First Name:NIKIAH
Middle Name:LILLIAN
Last Name:MOMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 SANDPIPER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-8129
Mailing Address - Country:US
Mailing Address - Phone:701-204-2561
Mailing Address - Fax:
Practice Address - Street 1:295 SANDPIPER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-8129
Practice Address - Country:US
Practice Address - Phone:701-204-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND68697376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide