Healthcare Provider Details

I. General information

NPI: 1023587300
Provider Name (Legal Business Name): AMAIRY NIEVES MEDINA BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB PUERTO NUEVO CALLE ARAGON BUZON 605
SAN JUAN PR
00920
US

IV. Provider business mailing address

URB PUERTO NUEVO CALLE ARAGON BUZON 605
SAN JUAN PR
00920
US

V. Phone/Fax

Practice location:
  • Phone: 787-696-2482
  • Fax:
Mailing address:
  • Phone: 787-696-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number33515A
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: