Healthcare Provider Details

I. General information

NPI: 1649324294
Provider Name (Legal Business Name): TAWANA NICHOLE NIX D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43563 1/2 HWY 299
FALL RIVER MILLS CA
96028
US

IV. Provider business mailing address

PO BOX 490
FALL RIVER MILLS CA
96028-0490
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-5910
  • Fax: 530-357-2862
Mailing address:
  • Phone: 530-336-6535
  • Fax: 530-294-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: