Healthcare Provider Details

I. General information

NPI: 1588532519
Provider Name (Legal Business Name): HEATHER RAE NIEMYER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

20220 E DOMINGO RD
QUEEN CREEK AZ
85142-9783
US

V. Phone/Fax

Practice location:
  • Phone: 480-468-4240
  • Fax:
Mailing address:
  • Phone: 480-468-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number334382
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN130284
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: