Healthcare Provider Details

I. General information

NPI: 1932384971
Provider Name (Legal Business Name): PAUL R. NILES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MILL ST
AKRON IA
51001-7712
US

IV. Provider business mailing address

PO BOX 328
SIOUX CITY IA
51102-0328
US

V. Phone/Fax

Practice location:
  • Phone: 712-568-2411
  • Fax: 712-568-2849
Mailing address:
  • Phone: 712-279-5830
  • Fax: 712-279-5843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001878
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: