MEDICARE: STACEY NIEVES NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	25NR11115300	NJ

General Provider Information

NPI Number	:	1336144146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY NIEVES NP

Provider Business Mailing Address
First Line	:	104 PHEASANT RUN
Second Line	:	SUITE 128
City	:	NEWTOWN
State	:	PA
Zip	:	18940-3439
Country	:	US
Telephone Number	:	215-860-3344
Fax Number	:	215-860-8950

Provider Business Practice Location Address
First Line	:	1 UNION ST
Second Line	:	SUITE 101
City	:	ROBBINSVILLE
State	:	NJ
Zip	:	08691-4219
Country	:	US
Telephone Number	:	609-890-7292
Fax Number	:	215-860-8950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/03/2013

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