Provider Demographics
NPI:1174075170
Name:MORALES, NIEVA JACUBA
Entity type:Individual
Prefix:MRS
First Name:NIEVA
Middle Name:JACUBA
Last Name:MORALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NIEVA
Other - Middle Name:JACUBA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5 TAFFY CT
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3523
Mailing Address - Country:US
Mailing Address - Phone:631-269-7241
Mailing Address - Fax:
Practice Address - Street 1:5 TAFFY CT
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3523
Practice Address - Country:US
Practice Address - Phone:631-269-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431733-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse