Healthcare Provider Details

I. General information

NPI: 1245351774
Provider Name (Legal Business Name): RANDI L NIEMEYER RNC NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1494 RENOIR AVE
SWANSEA IL
62226-8922
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6037
  • Fax:
Mailing address:
  • Phone: 618-222-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209007551
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number209007551
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number199137795
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: