Provider Demographics
NPI:1811705106
Name:NIELAND, MATTHEW RYAN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:NIELAND
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 1:1855 VANESS ST APT 4102
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-5711
Mailing Address - Country:US
Mailing Address - Phone:317-919-4921
Mailing Address - Fax:
Practice Address - Street 1:1855 VANESS ST APT 4102
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-5711
Practice Address - Country:US
Practice Address - Phone:317-919-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program