Healthcare Provider Details

I. General information

NPI: 1083349716
Provider Name (Legal Business Name): REBECA S NIEVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 GATEWAY BLVD STE 100
NEWBURGH IN
47630-8947
US

IV. Provider business mailing address

PO BOX 631767
CINCINNATI OH
45263-1767
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-2800
  • Fax:
Mailing address:
  • Phone: 812-450-6815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01097651A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: