Provider Demographics
NPI:1649077264
Name:MCVEA, NICOLE TARES
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TARES
Last Name:MCVEA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 W KNIGHTSBRIDGE CT APT B
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-6162
Mailing Address - Country:US
Mailing Address - Phone:463-280-5605
Mailing Address - Fax:
Practice Address - Street 1:6277 W KNIGHTSBRIDGE CT APT B
Practice Address - Street 2:
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-6162
Practice Address - Country:US
Practice Address - Phone:463-280-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN240179581253Z00000X, 3747A0650X, 3747P1801X, 376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker