MEDICARE: MACKENZIE NIEMEIER

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	374700000X	Technician

General Provider Information

NPI Number	:	1972215556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE NIEMEIER

Provider Business Mailing Address
First Line	:	210 E. 39TH STREET
Second Line	:
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776
Country	:	US
Telephone Number	:	402-494-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 C ST
Second Line	:
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3057
Country	:	US
Telephone Number	:	402-494-3501
Fax Number	:

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

Provider Enumeration Date	:	12/15/2022
Last Update Date	:	12/15/2022

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Directions to “ MACKENZIE NIEMEIER ” Practice Location

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