Healthcare Provider Details

I. General information

NPI: 1962383554
Provider Name (Legal Business Name): MRS. NIESHA ESTELLE FAIRHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIESHA ESTELLE GINN

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33643 FAIRHEAD DR
MERRIMAN NE
69218-6501
US

IV. Provider business mailing address

33643 FAIRHEAD DR
MERRIMAN NE
69218-6501
US

V. Phone/Fax

Practice location:
  • Phone: 308-430-3037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201656
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: