Nieraeth, Michael Robert

Nieraeth, Michael Robert is an individual health care provider with primary practice located at 8854 W Emerald St Ste 102 , Boise ID 83704. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Nieraeth, Michael Robert can be contacted via phone (208) 323-4747.

Contact Information

Primary practice address
8854 W Emerald St Ste 102 Boise ID 83704
Phone: (208) 323-4747
Fax: (208) 323-4848
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA-993 Idaho

Profile Details

NPI number 1487904280
LBN Legal business name Nieraeth, Michael Robert
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2012
Last updated Mar 25th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487904280 NPPES
Idaho MEDICAID 1487904280

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