Richard Clark Niessen SR., C.P.

NPI #1720318876 in Mpls, Minnesota

Provider Information

NPI Number: 1720318876
Entity Type: Individual
Name: Richard Clark Niessen SR., C.P.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Prosthetist
Credential: C.P.
Enumeration Date: Jan 12, 2010
Last Updated: Jan 12, 2010

Practice Location

Address: 2025 EAST RIVER PARK WAY
Address 2: SHRINERS HOSPITALS FOR CHILDREN TWIN CITIES
City: Mpls
State: Minnesota
ZIP Code: 55414-3604
Phone: (612) 596-6100

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Prosthetist	224P00000X	Primary

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