Healthcare Provider Details

I. General information

NPI: 1134039803
Provider Name (Legal Business Name): PHOENYX NIEDERMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W DODGE RD STE 106
OMAHA NE
68114-3430
US

IV. Provider business mailing address

1920 FARNAM ST APT 440
OMAHA NE
68102-1985
US

V. Phone/Fax

Practice location:
  • Phone: 402-575-5577
  • Fax:
Mailing address:
  • Phone: 574-275-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15030
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: