Provider Demographics
NPI:1376115535
Name:NIEDBALSKI, ASA MARIE (AGNP)
Entity type:Individual
Prefix:
First Name:ASA
Middle Name:MARIE
Last Name:NIEDBALSKI
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1597 COLD SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-5506
Mailing Address - Country:US
Mailing Address - Phone:574-274-2560
Mailing Address - Fax:
Practice Address - Street 1:1597 COLD SPRINGS DR
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-5506
Practice Address - Country:US
Practice Address - Phone:574-274-2560
Practice Address - Fax:317-219-0879
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71011321A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology