Provider Demographics
NPI:1003485194
Name:NIEMEYER, MARISSA CLAIRE (MSN, AGPCNP-C)
Entity type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:CLAIRE
Last Name:NIEMEYER
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Gender:F
Credentials:MSN, AGPCNP-C
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Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 MICHIGAN ST NE STE 3410
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2563
Practice Address - Country:US
Practice Address - Phone:616-391-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2025-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704330088363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology