Provider Demographics
NPI:1821058421
Name:NIEDERMIER, KAREN WYSE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:WYSE
Last Name:NIEDERMIER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:WYSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-3146
Mailing Address - Fax:
Practice Address - Street 1:2202 E 2ND ST STE 377
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3778
Practice Address - Country:US
Practice Address - Phone:715-817-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP1825363LF0000X
WI128436-2363LF0000X
MN128436-2363LF0000X
AKAK940363LF0000X
WI5989-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN205D0NIOtherBCBS
MNHP20370OtherHEALTH PARTNERS
MN111767OtherUCARE
MNNA9021026055OtherPREFERRED ONE
MN01-12315OtherMEDICA
MNNA9021026055OtherPREFERRED ONE