Provider Demographics
NPI:1275170813
Name:NIAVA, IRINA LILLIANE
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:LILLIANE
Last Name:NIAVA
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 1:463 MERRIMACK ST APT 10
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3946
Mailing Address - Country:US
Mailing Address - Phone:347-254-8271
Mailing Address - Fax:
Practice Address - Street 1:463 MERRIMACK ST APT 10
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3946
Practice Address - Country:US
Practice Address - Phone:347-254-8271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse