Provider Demographics
NPI:1144799107
Name:TORRES NIEVES, NICOLE ADRIANA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ADRIANA
Last Name:TORRES NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46060 MILLSTONE LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-2149
Mailing Address - Country:US
Mailing Address - Phone:301-863-4064
Mailing Address - Fax:
Practice Address - Street 1:46060 MILLSTONE LANDING RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2149
Practice Address - Country:US
Practice Address - Phone:301-863-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01757L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist