Provider Demographics
NPI:1295498517
Name:NIEVES, MAIZKA
Entity type:Individual
Prefix:MS
First Name:MAIZKA
Middle Name:
Last Name:NIEVES
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 1:1401 HAVEN RD APT A21
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3102
Mailing Address - Country:US
Mailing Address - Phone:787-459-1099
Mailing Address - Fax:
Practice Address - Street 1:1401 HAVEN RD APT A21
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3102
Practice Address - Country:US
Practice Address - Phone:787-459-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6J36PU6XH30Medicaid