| Doctor Name: | STACEY R NIEDER |
| NPI Number: | 1013989797 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 4552 |
| Business Practice Address: | 4001 Dale St Ste 210 Anchorage, AK - 995085445 |
| Business Phone Number: | 9079295888 |
| Business Fax Number: | 9079295882 |
| Mailing Address: | 4001 Dale St, Ste 210 ANCHORAGE |
| State: | AK |
| Postal Code: | 995085445 |
| Phone Number: | 9079295888 |
| Fax Number: | 9079295882 |
| NPI Enumeration Date: | 02/06/2006 |
| NPI Last Update Date: | 08/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4552 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |