Provider Demographics
NPI:1811036858
Name:NIEMAND, ENA MARIE
Entity Type:Individual
Prefix:
First Name:ENA
Middle Name:MARIE
Last Name:NIEMAND
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:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-0419
Mailing Address - Country:US
Mailing Address - Phone:505-609-2630
Mailing Address - Fax:505-327-6562
Practice Address - Street 1:525 S SCHWARTZ AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5955
Practice Address - Country:US
Practice Address - Phone:505-609-2630
Practice Address - Fax:505-609-2630
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist