Provider Demographics
NPI:1720318876
Name:NIESSEN, RICHARD CLARK SR (CP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLARK
Last Name:NIESSEN
Suffix:SR
Gender:M
Credentials:CP
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Mailing Address - Street 1:2025 EAST RIVER PARK WAY
Mailing Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3604
Mailing Address - Country:US
Mailing Address - Phone:612-596-6100
Mailing Address - Fax:612-330-5954
Practice Address - Street 1:2025 EAST RIVER PARK WAY
Practice Address - Street 2:SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55414-3604
Practice Address - Country:US
Practice Address - Phone:612-596-6100
Practice Address - Fax:612-330-5954
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist