Provider Demographics
NPI:1619476116
Name:NIETO, XIOMARA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:XIOMARA
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:XIOMARA
Other - Middle Name:
Other - Last Name:PIVARAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5433 W AGATITE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3501
Mailing Address - Country:US
Mailing Address - Phone:773-430-3359
Mailing Address - Fax:
Practice Address - Street 1:4070 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1831
Practice Address - Country:US
Practice Address - Phone:312-374-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily