Provider Demographics
NPI:1306092416
Name:NIENBURG, RHONDA MARIE
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:MARIE
Last Name:NIENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SW TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2503
Mailing Address - Country:US
Mailing Address - Phone:503-228-2154
Mailing Address - Fax:
Practice Address - Street 1:925 SW TAYLOR ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2503
Practice Address - Country:US
Practice Address - Phone:503-228-2154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician