Healthcare Provider Details

I. General information

NPI: 1962947051
Provider Name (Legal Business Name): CARLA NIESE L.I.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date: 06/14/2018
Reactivation Date: 04/20/2021

III. Provider practice location address

2884 ROAD 15
CONTINENTAL OH
45831-9530
US

IV. Provider business mailing address

2884 ROAD 15
CONTINENTAL OH
45831-9530
US

V. Phone/Fax

Practice location:
  • Phone: 419-234-5246
  • Fax:
Mailing address:
  • Phone: 419-234-5246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: