Provider Demographics
NPI:1932384971
Name:NILES, PAUL R (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:NILES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-0328
Mailing Address - Country:US
Mailing Address - Phone:712-279-5830
Mailing Address - Fax:712-279-5843
Practice Address - Street 1:321 MILL ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IA
Practice Address - Zip Code:51001-7712
Practice Address - Country:US
Practice Address - Phone:712-568-2411
Practice Address - Fax:712-568-2849
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001878363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical