Provider Demographics
NPI:1003649054
Name:NIEBUR, JOANN ELSIE (RN, CNM)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:ELSIE
Last Name:NIEBUR
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:JOANN
Other - Middle Name:ELSIE
Other - Last Name:BELAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1570 SOQUEL DR STE 3&4
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1707
Mailing Address - Country:US
Mailing Address - Phone:831-475-2200
Mailing Address - Fax:
Practice Address - Street 1:55 BRENNAN ST RM 201
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4342
Practice Address - Country:US
Practice Address - Phone:831-726-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95388128163W00000X
CA236483367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse