MEDICARE: MRS. KRISTIE LEE NIENABER PLPC

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	101YM0800X	Mental Health Counselor	2016025935	MO

General Provider Information

NPI Number	:	1659881191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIE LEE NIENABER PLPC

Provider Business Mailing Address
First Line	:	1480 WOODSTONE DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-6869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1480 WOODSTONE DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-6869
Country	:	US
Telephone Number	:	314-403-0392
Fax Number	:

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

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	10/11/2017

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