Provider Demographics
NPI:1023618279
Name:NIEZGODA, DAVID W
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:NIEZGODA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 OTTAWA RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1819
Mailing Address - Country:US
Mailing Address - Phone:419-729-2140
Mailing Address - Fax:
Practice Address - Street 1:2121 OTTAWA RIVER RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1819
Practice Address - Country:US
Practice Address - Phone:419-729-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker