Provider Demographics
NPI:1396909594
Name:NIEDERHAUSER, CURTIS D (PA-C)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:D
Last Name:NIEDERHAUSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2376 N 400 E
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074
Mailing Address - Country:US
Mailing Address - Phone:435-882-0071
Mailing Address - Fax:435-882-0073
Practice Address - Street 1:2376 N 400 E
Practice Address - Street 2:SUITE #104
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:435-882-0071
Practice Address - Fax:435-882-0073
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT293384-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant