Provider Demographics
NPI:1154959237
Name:NIENTIMP, LUKE (DO)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:NIENTIMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 INDIANA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2126
Mailing Address - Country:US
Mailing Address - Phone:814-823-4803
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST STE 103A
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1471
Practice Address - Country:US
Practice Address - Phone:814-877-8540
Practice Address - Fax:814-877-8541
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.031336207R00000X
PAOS022611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine