Healthcare Provider Details

I. General information

NPI: 1962297887
Provider Name (Legal Business Name): KURT RAYMOND NIEBAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EILEEN DONDERO FOLEY AVE STE 203
PORTSMOUTH NH
03801-4595
US

IV. Provider business mailing address

6 CYPRESS LN APT 4
NASHUA NH
03063-2327
US

V. Phone/Fax

Practice location:
  • Phone: 603-427-6868
  • Fax: 603-883-0007
Mailing address:
  • Phone: 216-970-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: