Healthcare Provider Details

I. General information

NPI: 1740710102
Provider Name (Legal Business Name): BILLIE NIEHOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE STE 1D03
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

1119 CREEKSIDE CIR
HINESVILLE GA
31313-2575
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-5092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number9334497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: