Provider Demographics
NPI:1891419792
Name:PFEIFFER, NIPUNI MADARA
Entity Type:Individual
Prefix:
First Name:NIPUNI
Middle Name:MADARA
Last Name:PFEIFFER
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 1:749 MARION PIKE
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638-3036
Mailing Address - Country:US
Mailing Address - Phone:740-547-9721
Mailing Address - Fax:
Practice Address - Street 1:1162 COUNTY ROAD 17
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-7667
Practice Address - Country:US
Practice Address - Phone:740-547-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OH408097163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant