Provider Demographics
NPI:1922303759
Name:NIESE, SARAH WISCHMEYER (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:WISCHMEYER
Last Name:NIESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:L
Other - Last Name:WISCHMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:520 W LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-9466
Practice Address - Country:US
Practice Address - Phone:419-634-2015
Practice Address - Fax:419-634-9420
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003202363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067924Medicaid
OHH029291Medicare PIN