Jon D Niewolny, PA-C
Physician Assistant in Sheboygan, WI. Individual provider (NPI-1).
NPI number1700993151
StatusActive
Last updated in NPPESAug 5, 2024
Details
- NPI
- 1700993151
- Entity type
- Individual (NPI-1)
- Name
- Mr. Jon D Niewolny
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 23, 2006
- Certification date
- Aug 5, 2024
- Last updated
- Aug 5, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 1899-23 | WI | Yes |
Practice location
3400 Union AveSheboygan, WI 53081-8426
Phone 920-828-2530
Mailing address
Po Box 735044Chicago, IL 60673-5044
Phone 800-326-2250
Other practice locations
2414 Kohler Memorial Dr
Sheboygan, WI 53081
Sheboygan, WI 53081
Phone 920-457-4461 · Fax 920-459-1460
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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