Healthcare Provider Details

I. General information

NPI: 1215852447
Provider Name (Legal Business Name): NANCY I NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 WOLF MEADOW CV
CORDOVA TN
38018-7708
US

IV. Provider business mailing address

567 WOLF MEADOW CV
CORDOVA TN
38018-7708
US

V. Phone/Fax

Practice location:
  • Phone: 706-255-0794
  • Fax:
Mailing address:
  • Phone: 706-255-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8322
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: