Provider Demographics
NPI:1982290862
Name:NIEKAMP, LORA ANN
Entity type:Individual
Prefix:MISS
First Name:LORA
Middle Name:ANN
Last Name:NIEKAMP
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 1:5325 BURKHARDT RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2147
Mailing Address - Country:US
Mailing Address - Phone:937-681-0996
Mailing Address - Fax:
Practice Address - Street 1:5325 BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-2147
Practice Address - Country:US
Practice Address - Phone:937-681-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide