Healthcare Provider Details

I. General information

NPI: 1326969627
Provider Name (Legal Business Name): TIMOTHY NIENHUESER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8512 BOUNDARY AVE APT D5
ANCHORAGE AK
99504-1450
US

IV. Provider business mailing address

8512 BOUNDARY AVE APT D5
ANCHORAGE AK
99504-1450
US

V. Phone/Fax

Practice location:
  • Phone: 308-249-3503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number193271
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: