Provider Demographics
NPI:1952478943
Name:ANTOLOVIC-STANFEL, NIVES (MD)
Entity Type:Individual
Prefix:
First Name:NIVES
Middle Name:
Last Name:ANTOLOVIC-STANFEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIVES
Other - Middle Name:
Other - Last Name:ANTOLOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9216 SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7476
Mailing Address - Country:US
Mailing Address - Phone:919-637-7543
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:DURHAM VAMC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0097-012212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG90791Medicare UPIN