Healthcare Provider Details

I. General information

NPI: 1649077264
Provider Name (Legal Business Name): NICOLE TARES MCVEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6277 W KNIGHTSBRIDGE CT APT B
MCCORDSVILLE IN
46055-6162
US

IV. Provider business mailing address

6277 W KNIGHTSBRIDGE CT APT B
MCCORDSVILLE IN
46055-6162
US

V. Phone/Fax

Practice location:
  • Phone: 463-280-5605
  • Fax:
Mailing address:
  • Phone: 463-280-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number240179581
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number240179581
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number240179581
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number240179581
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number240179581
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: