| Doctor Name: | MARY J NIEMEYER |
| NPI Number: | 1477530475 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 4704190536 |
| Business Practice Address: | 3828 Kentucky Ln Hudsonville, MI - 494268107 |
| Business Phone Number: | 6163404633 |
| Business Fax Number: | |
| Mailing Address: | 3828 Kentucky Lane, HUDSONVILLE |
| State: | MI |
| Postal Code: | 494260000 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/30/2005 |
| NPI Last Update Date: | 05/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704190536 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |