Provider Demographics
NPI:1649324294
Name:NIX, TAWANA NICHOLE (DO)
Entity type:Individual
Prefix:DR
First Name:TAWANA
Middle Name:NICHOLE
Last Name:NIX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER MILLS
Mailing Address - State:CA
Mailing Address - Zip Code:96028-0490
Mailing Address - Country:US
Mailing Address - Phone:530-336-6535
Mailing Address - Fax:530-294-5801
Practice Address - Street 1:43563 1/2 HWY 299
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028
Practice Address - Country:US
Practice Address - Phone:530-246-5910
Practice Address - Fax:530-357-2862
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9774207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine