Individual
NANCI ROTH NILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2134 MARY SHERMAN DR, SULLIVAN, IN 47882-7625
(812) 268-6376
(812) 268-6377
Mailing address
2134 MARY SHERMAN DR, SULLIVAN, IN 47882-7625
(812) 268-6376
(812) 268-6377
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041814A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200396290
—
IN
Enumeration date
09/14/2005
Last updated
05/23/2011
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