Individual
CARLOS A NIEVES III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1526 N TAYLOR DR, SHEBOYGAN, WI 53081-1927
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7802-23
WI
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100285468
—
WI
Enumeration date
07/31/2023
Last updated
07/08/2026
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