Provider Demographics
NPI:1902375363
Name:NIDER, DONNA JEAN
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:NIDER
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 1:62434 HIGHWAY 8
Mailing Address - Street 2:
Mailing Address - City:PAWNEE CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68420-2563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7909 REED ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4431
Practice Address - Country:US
Practice Address - Phone:402-898-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse