Healthcare Provider Details

I. General information

NPI: 1245175199
Provider Name (Legal Business Name): ELIEL NIEVES TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E. VETERAN STREET
TOMAH WI
54660
US

IV. Provider business mailing address

1010 BERRY AVE APT 311
TOMAH WI
54660-4463
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-3971
  • Fax:
Mailing address:
  • Phone: 608-849-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number075474
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: