Healthcare Provider Details

I. General information

NPI: 1417625096
Provider Name (Legal Business Name): DIANA PATRICIA GARCIA NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COOPER RD STE 16
VOORHEES NJ
08043-8007
US

IV. Provider business mailing address

1683 WASHINGTON AVE
VINELAND NJ
08361-8482
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-2224
  • Fax:
Mailing address:
  • Phone: 732-456-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01181500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: