Provider Demographics
NPI:1336630417
Name:NIEMANN, CARISSA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:SPEED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:204 LOWE AVE SE STE 2
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4242
Mailing Address - Country:US
Mailing Address - Phone:256-517-8861
Mailing Address - Fax:256-517-8872
Practice Address - Street 1:204 LOWE AVE SE STE 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4242
Practice Address - Country:US
Practice Address - Phone:256-517-8861
Practice Address - Fax:256-517-8872
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-110336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily