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General NPI Number Information
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NPI Number | 1861435679
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Entity Type | Individual
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Provider Name | WILLIAM HENRY NIEMEYER III P.A.-C
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 385 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4357
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Country | US
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Telephone | 860-777-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 1832 ASHLEY DRIVE
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City | CHARLESTON
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State | IL
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Zip | 61920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01134
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 004173
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-001528
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License Number State | IL
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