Healthcare Provider Details

I. General information

NPI: 1629015201
Provider Name (Legal Business Name): VICTOR N NIEMI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

P.O. BOX 024912
MIAMI FL
33102-4912
US

V. Phone/Fax

Practice location:
  • Phone: 877-538-4594
  • Fax: 866-665-2702
Mailing address:
  • Phone: 877-538-4594
  • Fax: 866-665-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9176498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: