MEDICARE: MRS. ANITRA MARIE NIECE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	346788	OH
2	163W00000X	Registered Nurse	28231560A	IN
3	363LF0000X	Family Nurse Practitioner	4038591	KY
4	363LF0000X	Family Nurse Practitioner	0029085	OH

General Provider Information

NPI Number	:	1023606944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANITRA MARIE NIECE RN

Provider Business Mailing Address
First Line	:	10864 PIPPIN RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-1546
Country	:	US
Telephone Number	:	513-307-5798
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 WERK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45248-4900
Country	:	US
Telephone Number	:	513-452-0929
Fax Number	:	513-540-4909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	05/31/2025

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