Provider Demographics
NPI:1083319115
Name:NIEMAN, KATELYN (NP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:PO BOX 40412
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-1255
Mailing Address - Country:US
Mailing Address - Phone:414-255-0340
Mailing Address - Fax:855-342-0199
Practice Address - Street 1:1000 BURR RIDGE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0864
Practice Address - Country:US
Practice Address - Phone:414-255-0340
Practice Address - Fax:855-342-0199
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2025-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI13642-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology