Provider Demographics
NPI:1245905470
Name:BURCIAGA, NYSHA RAINA
Entity type:Individual
Prefix:
First Name:NYSHA
Middle Name:RAINA
Last Name:BURCIAGA
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 1:1424 S. MAIN ST. ADRIAN, MI 49221
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221
Mailing Address - Country:US
Mailing Address - Phone:517-662-9687
Mailing Address - Fax:
Practice Address - Street 1:1424 S. MAIN ST. ADRIAN, MI 49221
Practice Address - Street 2:SUITE 3
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:151-731-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician