Healthcare Provider Details

I. General information

NPI: 1366333478
Provider Name (Legal Business Name): CALLIE RAE NIEMANN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 U S 89
FLAGSTAFF AZ
86004
US

IV. Provider business mailing address

5130 N US HIGHWAY 89
FLAGSTAFF AZ
86004-2837
US

V. Phone/Fax

Practice location:
  • Phone: 928-773-2054
  • Fax:
Mailing address:
  • Phone: 928-773-2054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberDA16519
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: