Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 241605 | MA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME128094 | FL |
NPI | 1871729665 |
---|---|
Provider Name | Maria Nieto |
First Address | Stuart, FL 34994-2503 |
Second Address | Stuart, FL 34994-2503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017290600 | (05) | FL |