Healthcare Provider Details

I. General information

NPI: 1053585174
Provider Name (Legal Business Name): BRENT JEFFREY NIENABER CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6669 MORRISON DR
DENVER CO
80221
US

IV. Provider business mailing address

6669 MORRISON DR STE 360
DENVER CO
80221-2660
US

V. Phone/Fax

Practice location:
  • Phone: 303-803-4004
  • Fax:
Mailing address:
  • Phone: 303-339-1499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: