Healthcare Provider Details

I. General information

NPI: 1609492107
Provider Name (Legal Business Name): KATHERINE NIEMELA RN, MN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 W 4TH ST SUITE 5
LOS ANGELES CA
90036
US

IV. Provider business mailing address

6400 PRIMROSE AVE APT 8
HOLLYWOOD CA
90068-2899
US

V. Phone/Fax

Practice location:
  • Phone: 310-880-4737
  • Fax:
Mailing address:
  • Phone: 310-880-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN386956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: