Provider Demographics
NPI:1104596329
Name:COLLINS-NIEMEYER, THERESA ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANN
Last Name:COLLINS-NIEMEYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 BOWLING ST SW STE C
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5070
Mailing Address - Country:US
Mailing Address - Phone:319-531-3824
Mailing Address - Fax:
Practice Address - Street 1:5005 BOWLING ST SW STE C
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5070
Practice Address - Country:US
Practice Address - Phone:319-531-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP27516164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse