Provider Demographics
NPI:1841034907
Name:NIEWOEHNER, BRYCE (PA)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:NIEWOEHNER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 HARDING MEMORIAL PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6347
Mailing Address - Country:US
Mailing Address - Phone:740-383-5115
Mailing Address - Fax:740-387-3668
Practice Address - Street 1:1051 HARDING MEMORIAL PKWY STE B
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6347
Practice Address - Country:US
Practice Address - Phone:740-383-5115
Practice Address - Fax:740-387-3668
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008777RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty