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General NPI Number Information
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NPI Number | 1235667049
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Entity Type | Individual
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Provider Name | NIVETHA VISHNUVARDHAN
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Gender | Female
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Dates
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Enumeration Date | 05/24/2017
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2076 NC HIGHWAY 42 W STE 130
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City | CLAYTON
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State | NC
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Zip | 27520-5303
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Country | US
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Telephone | 919-585-8833
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Fax | 919-585-8840
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Provider Business Mailing Address
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Address Line | 5221 PARAMOUNT PKWY STE 220
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City | MORRISVILLE
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State | NC
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Zip | 27560-5490
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 2023-01444
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License Number State | NC
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