MEDICARE: STEPHANIE NIEMANN

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	163WG0000X	General Practice Registered Nurse	1690441	CO

General Provider Information

NPI Number	:	1194671867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NIEMANN

Provider Business Mailing Address
First Line	:	5245 ZACHARY GRV APT 304
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-5528
Country	:	US
Telephone Number	:	719-300-4955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 DOMINION WAY STE 201
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-8451
Country	:	US
Telephone Number	:	719-300-4955
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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