Doctor Name: | PETER JOSEPH NINNEMAN |
NPI Number: | 1033519673 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 2014009981 |
Business Practice Address: | 21 Municipal Dr Arnold, MO - 630101012 |
Business Phone Number: | 6362966206 |
Business Fax Number: | |
Mailing Address: | 21 Municipal Dr, ARNOLD |
State: | MO |
Postal Code: | 630101012 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/02/2014 |
NPI Last Update Date: | 09/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 2014009981 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |