MR. MICHAEL ROBERT NIERAETH (NPI# 1487904280) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487904280 |
| Entity Type | Individual |
| Full Name | MR. MICHAEL ROBERT NIERAETH |
| Credential | PA |
| Practice Address |
8854 W Emerald St Ste 102 Boise ID 83704 |
| Mailing Address |
8854 W Emerald St Ste 102 Boise ID 83704-4845 |
| Practice Telephone | 2083234747 |
| Practice Fax Number | 2083234848 |
| Mailing Telephone | 2083234747 |
| Mailing Fax Number | 2083234848 |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2019-03-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA-993 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1487904280 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 320 Warner Dr, Lewiston, ID 835014441 | 2087433523 | 2087468741 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295166882 | Michael Jan Nieraeth | Physical Therapist | 1011 Baldwin Park Blvd, Baldwin Park, CA 91706-5806 | 2013-12-06 |
| Street Address |
8854 W EMERALD ST STE 102 |
| City | BOISE |
| State | ID |
| Zip Code | 83704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205944303 | Joseph Randall Lynch | Orthopaedic Surgery | 8854 W Emerald St Ste 102, Boise, ID 83704-4845 | 2006-08-28 |
| 1164063368 | Kiira Vazales | Orthopaedic Surgery | 8854 W Emerald St Ste 102, Boise, ID 83704-4845 | 2019-09-30 |
| 1891982559 | Jared S Johnson | Orthopaedic Surgery | 8854 W Emerald St Ste 102, Boise, ID 83704-4845 | 2007-09-26 |
| 1861575797 | Jeffrey J. Griggs | Specialist/Technologist | 8854 W Emerald St Ste 102, Boise, ID 83704-4845 | 2006-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
| Find all providers in zip 83704 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1891707618 | Brian Keith Lachapelle | Physician Assistant | 6140 W Curtisan, Ste 102, Boise, ID 83704 | 2006-08-12 |
| 1780641530 | Alicia R Borst | Physician Assistant | 3960 W. Wainwright, Boise, ID 83713 | 2006-04-26 |
| 1679090617 | Joel Timothy Mathews | Physician Assistant | 100 E Warm Springs Ave Ste B, Boise, ID 83712-6243 | 2017-08-29 |
| 1073982245 | Kim Wilson | Physician Assistant | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2015-09-17 |
| 1710362710 | Andrew P Swenson | Physician Assistant | 6165 W Emerald, Boise, ID 83704 | 2015-07-21 |
| 1275936981 | Shaylan Pease | Physician Assistant | 6259 W Emerald St, Boise, ID 83704-8731 | 2014-10-08 |
| 1194127472 | Anna Hoskins | Physician Assistant | 1072 N Liberty Street, Ste 201, Boise, ID 83704-8708 | 2014-09-18 |
| 1568891638 | Dominick Valentine | Physician Assistant | 6140 W Curtisian Ave, Suite 102, Boise, ID 83704-8880 | 2013-11-08 |
| 1013342468 | Polina Kokoulina | Physician Assistant | 900 N Liberty St, Ste 101, Boise, ID 83704-8704 | 2013-09-04 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.