Provider Demographics
NPI:1629308929
Name:NIEMYER, CARISSA LYNN (CD(DONA))
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNN
Last Name:NIEMYER
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3103
Mailing Address - Country:US
Mailing Address - Phone:719-731-0916
Mailing Address - Fax:
Practice Address - Street 1:520 S 26TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3103
Practice Address - Country:US
Practice Address - Phone:719-731-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula