Provider Demographics
NPI:1962383554
Name:FAIRHEAD, NIESHA ESTELLE
Entity type:Individual
Prefix:MRS
First Name:NIESHA
Middle Name:ESTELLE
Last Name:FAIRHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIESHA
Other - Middle Name:ESTELLE
Other - Last Name:GINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33643 FAIRHEAD DR
Mailing Address - Street 2:
Mailing Address - City:MERRIMAN
Mailing Address - State:NE
Mailing Address - Zip Code:69218-6501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33643 FAIRHEAD DR
Practice Address - Street 2:
Practice Address - City:MERRIMAN
Practice Address - State:NE
Practice Address - Zip Code:69218-6501
Practice Address - Country:US
Practice Address - Phone:308-430-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program