Provider Demographics
NPI:1619616901
Name:NIEVA, NATHANIEL THOMAS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:THOMAS
Last Name:NIEVA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:670 N COMMERCIAL ST APT LL13
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1150
Mailing Address - Country:US
Mailing Address - Phone:978-732-8022
Mailing Address - Fax:
Practice Address - Street 1:185 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-625-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2023-03-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant