Basic Information
| Provider Information | |||||||||
| NPI: | 1770079469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIESSEN | ||||||||
| FirstName: | ELLES | ||||||||
| MiddleName: | SANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 485 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473620485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655211516 | ||||||||
| FaxNumber: | 7655993131 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 N 16TH ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655211217 | ||||||||
| FaxNumber: | 7655211218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2018 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71008109A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.