Provider Demographics
NPI:1467635789
Name:NIEMEYER, AGNIESZKA J (MD)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:J
Last Name:NIEMEYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 NORTH 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382
Mailing Address - Country:US
Mailing Address - Phone:360-681-6900
Mailing Address - Fax:360-681-6222
Practice Address - Street 1:558 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-681-6900
Practice Address - Fax:360-681-6222
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048475207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873508OtherMEDICARE GROUP PTAN
WA1699947200OtherNPI GROUP
WAG8873509OtherMEDICARE INDIVIDUAL PTAN
H99313Medicare UPIN
WA00A733660Medicare PIN
WA1699947200OtherNPI GROUP
00A733660Medicare PIN