Healthcare Provider Details

I. General information

NPI: 1134558984
Provider Name (Legal Business Name): JEANETTE L NIENABER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 SEWARD HWY
SEWARD AK
99664-9733
US

IV. Provider business mailing address

PO BOX 2088 2035 SEWARD HIGHWAY
SEWARD AK
99664-2088
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-3490
  • Fax: 907-802-4436
Mailing address:
  • Phone: 907-224-3490
  • Fax: 907-802-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number104716
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: