Healthcare Provider Details

I. General information

NPI: 1093480113
Provider Name (Legal Business Name): MICHAEL T NIEHUSS MSN, CRNP, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 DAUPHIN ST STE 301
MOBILE AL
36606-4052
US

IV. Provider business mailing address

PO BOX 21595
BELFAST ME
04915-4112
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5930
  • Fax: 251-660-5931
Mailing address:
  • Phone: 251-300-5941
  • Fax: 251-660-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-105485
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: